Uncertainty, Decision-making And Team Work In High-tech Healthcare: Person-soulmindbody-hood & Relational Medicine

228 Pages·2022·10.824 MB·English

by  Federica Raia, Mario C. Deng, Murray Kwon

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Published by
World Scientific Publishing Co. Pte. Ltd.
5 Toh Tuck Link, Singapore 596224
USA office: 27 Warren Street, Suite 401-402, Hackensack, NJ 07601
UK office: 57 Shelton Street, Covent Garden, London WC2H 9HE
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library.
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w. Copyright © 2023 by World Scientific Publishing Co. Pte. Ltd.
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m All rights reserved. This book, or parts thereof, may not be reproduced in any form or by any means,
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For photocopying of material in this volume, please pay a copying fee through the Copyright Clearance
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SHORT SUMMARY
Grounded in the insight that “High-tech medicine is forcing new terri-
tories for humans to dwell in,” in 2015, we published our conceptual
and methodological framework “Relational Medicine — Personalizing
Modern Healthcare: The Practice of High-Tech Medicine as a Relational
Act.” We build on this framework and put it to work in “Uncertainty,
Decision-Making and Team Work in High-tech Healthcare: PERSON-
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o SoulMindBody-HOOD & Relational Medicine.” This book presents a
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ntific. fully developed single case analysis consisting of recorded consecutive
e encounters in a dramatically accelerating life-and-death decision-making
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orld situation in the high-tech medical practice of Advanced Heart Failure
w (AdHF)inateaching hospital.
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w We analyze the recorded medical encounter interactions during which
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practitioners, patient, andfamily face multiple uncertainties asadecision-
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w care unit nurse, and Fellows — discuss AdHF life-prolonging options
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with their patient and family. We make visible the essential roles of each
multidisciplinary teammemberinhelpingframeforthepatientandfamily
whatitisthatisgoingonandthechangingavailableoptionswhileattending
tothepatient’ssoul-mind-body.Inbringingdifferentdata,perspectives,and
facets ofunderstanding tobear, thisbook offers anovelapproach tostudy
high-tech medical care grounded in the actual everyday practice. Using a
micro-ethnographic data analysis, we unravel a heretofore unrecognized
universe ofpractice themesandpresent suggestions formedicaleducation
andtraining aimedatcontinuous reflectionsonpracticeimprovement.
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ACKNOWLEDGMENTS
Many people have contributed to the current book. The Raia Relational
Ontology&PhenomenologyofPracticelabteamatUCLAworkedforyears
tirelessly onthis case analysis. Formerand current team members include
Naa’im Eggleton, Srikanth Krishnan, Jennifer Plotkin, Nadine Tanio, and
IrinaSilacheva.
Federica’s Raia Care Learning and Becoming Lab (the C_LaB), a
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o qualitativedataanalysisinterestgroupcomposedofeducationresearchers,
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ntific. linguistanthropologists, medicalpractitioners,andstudentsprovidedaddi-
e tionalspacetodiscussthemethodologicalaswellaspractice-relatedissues
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orld relevanttothisbook.SpecialthanksgototheparticipantsincludingMarjorie
w HGoodwin,JuliaKatila,SrikanthKrishnan,LezelLegadosIrinaSilacheva,
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w AnaElviraSteinbach Torres,SirajSodhi,andMenelikTafari.
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The numerous residents in Mario Deng’s monthly lecture “Decision-
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oa members, specifically Moira Kelly, inthe Ronald-Reagan UCLAMedical
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w CenterCriticalCareUnit(CCU)wereinstrumental incritically advancing
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theresearch team’sanalytical andconceptual thought process.
The UCLA cross-campus cross-school project would not have been
possible without the leadership support of the School of Education &
InformationStudies(EI&IS),DavidGeffenSchoolofMedicine(DGSOM)
andUCLAHealth.
InspirationcontinuedtocomefromtheRelationalMedicineFoundation,
namely CandaceMoose, JimMoose, andVictoriaGroysberg; ourpatients
and their families; Brent and Tracy Shubin; and our families, specifically
ourbelovedmothersLilianaMonaco,SuYongKwonandEvaDeng.
Forhercontinuoussupportandencouragementandherconstructiveand
insightful comments,wethankProfessorMarjory(Candy)H.Goodwin.
Federica’s mentor and spiritus rector Professor Charles (Chuck)
Goodwin was — before and after his untimely passing — a continuous
inspirational interlocutor.
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ABOUT THE AUTHORS
Federica Raia, PhD, is associate professor at UCLA in the School of
Education and Information Studies (SE&IS) and in the David Geffen
School of Medicine at UCLA (https://seis.ucla.edu/faculty-and-research/
faculty-directory/federica-raia).
Herworkfocusesonstudyingprofessional practicesofcareinMedical
andEducationcontextswhereprofessionals,albeitinthespecificityofeach
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o situation and community, confront the complex and important question
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ntific. of How to care for the Other in need to develop a new and meaningful
e sense of being in the world. Her work is situated at the crossroads of
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orld learning, sciences and technology, and the concept of personhood. It is
w informed by complexity science and continental philosophy, in particular,
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w Martin Heidegger’s and Maurice Merleau-Ponty’s philosophical work on
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fundamental ontology and phenomenology ofthe lived experience always
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Withinthisframeworkshefocusesontherelationalaspectofencountering
the Other in asymmetrical power and knowledge distribution situations as
itisthecaseinteacher/studentanddoctor/patientencounters.Asdiscussed
inherwork, intheprofessional practices ofboth educators and healthcare
practitioners, theethical imperativetocareispartofthesocialpositioning
(1)manifestedintheworldinhabited bytheprofessionals incaringforthe
Otherand(2)towardoneself,takingastandonone’sownpathofbecoming
thiskindofpractitioner.
Dr Raia studies practices at the interactional level. The ethnographic
microanalyses ofaudio-video recordedinteractions makevisible:
(cid:129) WhatitmeanstocarefortheOther
(cid:129) Whatitmeansto“notice”inpractice
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