David Glickman: VHA's Ethics Hero - Organizational Excellence
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David Glickman: VHA's Ethics Hero

David Glickman is a first-responder of a different kind. The other day, a patient came to have stitches removed at VA Puget Sound Health Care System's Seattle campus.

Along with his service animal, he brought a puppy. "Who doesn't love puppies?" Glickman says, "But he was claiming the puppy was a service dog in training and bullying the nurses about it." That's when his pager buzzed. It was an ethical emergency, and Glickman was first to the scene.

David Glickman with the 2019 William A Nelson Award for Excellence in Health Care Ethics

Photo credit: Chris Pacheco, Visual Information Specialist, Medical Media, VA Puget Sound Health Care System

As the IntegratedEthics Program Officer, Glickman arrived in the waiting room and took a seat next to the agitated patient. He pulled out his copy of VHA's policy on service animals and respectfully explained that, while the puppy was adorable, only fully-trained service animals are allowed at the facility.

"We are able to serve all Veterans better when we maintain a professional medical environment," Glickman says. "When that environment is undermined, we have to resolve those conflicts and issues."

Glickman admits, resolving those conflicts is not always easy. In the field of ethics and preventive ethics, he covers issues even physicians and nurses struggle with, like how to talk with patients about end-of-life care.

In fact, as the facility coordinator for the Life-Sustaining Treatment (LST) Decisions Initiative, Glickman is responsible for ensuring physicians and nurses at VA Puget Sound Health Care System are trained on how to have in-depth conversations with patients about their end-of-life care, preferably before an emergency or terminal illness takes place.

"It's not just, 'Are you DNR (do not resuscitate), yes or no?'" Glickman says. "We're trying to improve the quality of the discussion, so patients understand and convey their values, goals and preferences. It needs to be compassionate and in the right setting," he adds.

He sees this first-hand with his father, a World War II Veteran who receives medical care at the same VA facility where Glickman works. "I take my dad to his appointments and watch how the provider talks about end-of-life care with him," Glickman says. "The physician, who we previously trained, will come to me afterwards and say, ‘Hey, did I have that conversation the right way?'"

Since May 2018, when the LST Decisions Initiative began, over 1,000 of these discussions have been recorded in patients' medical records at VA Puget Sound and hundreds of staff members have been trained on how to have these "crucial conversations", as Glickman describes them. Now, once a patient's preferences are recorded, they simply need to be confirmed at follow-up appointments, not repeated at each check-up, as done in the past.

"Before the initiative, they kept asking my dad if he wanted to be DNR, and he was so annoyed," Glickman says. At his last check-up, his father was pleased to simply confirm his DNR and not start the conversation all over again.

Photo

Photo credit: Chris Pacheco, Visual Information Specialist, Medical Media, VA Puget Sound Health Care System

"I get to see the impact this has on Veterans through my dad's experience," Glickman adds. "It's truly an honor to give back to him and create an environment for other Veterans that is compassionate to those who are struggling with medical issues or those confronted with a disability."

Glickman received the 2019 VHA William A. Nelson Award for Excellence in Health Care Ethics for his long-term commitment to promoting ethical health care practice in VHA. "Mr. Glickman truly embodies the spirit of VA's ethics program," says Dr. Ken Berkowitz, acting director of the VA National Center for Ethics in Health Care. "For decades, Mr. Glickman has shown exceptional dedication and commitment to promoting strong ethics practices across VA — one patient, one policy at a time — through both his creative outreach to front-line staff and his shaping of medical center policy," Dr. Berkowitz adds.

In 1980, Glickman joined the Department of Veteran Affairs after graduating from college with a degree in manual arts therapy specifically designed for employment at VA. He began at the VA Medical Center in Leavenworth, Kansas, teaching woodworking and furniture restoration as a form of therapy for Veterans. Later, he served as a Quality Consultant after receiving a graduate degree in organizational leadership. In 2012, he joined the IntegratedEthics® Program at VA Puget Sound, Washington.

For more information on VA's IntegratedEthics Program and the Nelson Award, visit the National Center for Ethics in Health Care. On behalf of the Office of Organizational Excellence, we are tremendously proud of David Glickman and the exceptional work he does every day to ensure Veterans receive compassionate, high-quality healthcare.