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The physician can play a leadership role in detoxifying death for the patient, the family, and the professional staff. However, physicians commonly manifest avoid ance and other dysfunctional behaviors when dealing with death. Dysfunctional physician behaviors around death are not rooted in cognitive understanding and are resistant to conventional didactic approaches (SUPPORT Principal Investigators, 1995). Physician responses to end-of-life patients are affected by the power of childhood memories, personal beliefs, attitudes and unexamined conclusions drawn from medical training. To affect behavioral change, a curriculum was developed that creates an intensive community of inquiry among physician peers to examine existing beliefs in depth and to motivate, validate, and support new behaviors. The curriculum on Detoxifying Death for Physicians was implemented 12 times over a three-year period. Physicians from the United States and Canada, representing a wide range of specialties and practice styles, participated in the curriculum. Participants reported significant attitudinal and behavioral change in the direction of increased comfort in caring for patients at the end of life and in discussing death and dying with colleagues. The Institute for the Study of Health and Illness's (ISHI) experience with this multimodal curriculum suggests that it is possible for mature physicians to significantly alter their attitudes and behaviors toward end-of-life patients through participation in an intensive educational process. It also suggests that change may be a function of the depth and integrity of the educational process rather than the length of exposure to the curriculum.

Educating for Compassion: Detoxifying Death for Physicians' CME Curriculum