A Tunneled Catheter Placement Program for Community Hospices.

Context: The symptoms associated with the excessive fluid accumulation of ascites or pleural effusions can be intractable to medical management and can have a significant negative impact on quality of life of hospice patients. Hospice of the Valley, a community-based, nonprofit hospice agency has historically referred patients to outpatient providers for paracentesis, thoracentesis, and placement of tunneled drainage catheters.

Objectives: To describe an in-house pilot program of tunneled catheter placement to provide immediate and longer-term symptom relief for selected hospice patients.

Responding to Callous Humor in Health Care.

Although humor in health care can facilitate relationship building between patients and clinicians, callous humor used to deflect or dismiss distressing emotions undermines relationships, erodes trust, and expresses disregard for vulnerability. Because it affects collegiality, training, and patient care, callous humor should not be tolerated, especially when directed at patients. This article considers why it is important to respond to colleagues who make callous jokes and suggests how to do so.