I wanted to be good at this and worked hard to achieve competency. As an oncology fellow, palliative care is everything it was before, but it has taken on a new dimension for me now — it is a refuge. Providing good oncology care is hard, as everyone knows, because cancer is difficult to treat. Curable cancers require expertly delivered, intensive therapy to achieve success. Incurable disease requires similar skill in maneuvering cancer treatment modalities to prolong life.
The discussions in cancer center disease treatment groups, or multidisciplinary tumor board conferences, or beyond the walls through cooperative clinical trial groups or professional society meetings all focus on the nature and arrangement of therapeutic strategies to improve DFS or PFS or OS.
The emphasis changes from fighting a disease to providing comfort for a person. Paradoxically, though the goal is no longer cure or prolongation of life, providing this kind of care can feel extremely satisfying. Maybe this is because the skills required — the listening, the responding to concerns, the providing relief from physical, psychological or existential suffering — feel like what doctoring is supposed to be.
On an inpatient palliative care consult service, in the midst of a frenetic hospital environment where physicians run in and out of rooms to order and check labs and tests and write discharge summaries, the activities mandated by the palliative care consult service — staying longer, sitting down and actually talking with patients and families — can feel very satisfying too.
Did I do everything I could? Is there another treatment I should have offered? I remember a patient of mine with metastatic breast cancer who recently died. At one point in her care, consistent with her wishes, I provided a referral to hospice and switched to a primarily palliative mode.
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Visit our Privacy Policy and Cookie Policy to learn more. You can opt out of some cookies by adjusting your browser settings. In palliative care you have to treat the patient as a person. Rosenberg : We do. Palliative care, on the other hand, is non-curative symptom management. This means that with the person with the brain tumor, we not only treat their tumor but we treat their symptoms.
We treat their nausea, their pain, their vomiting, their diarrhea, whatever it may be. As the person goes along their continuum, as they go from presentation of their illness to terminally ill, what happens is we start doing less curative measures and more palliative or non-curative measures.
EPM : It seems to me that many patients come to us for treatment of their symptoms rather than diagnosis or definitive treatment of their disease.
They want to feel better. And end-of-life care or terminal care is really just an extension of that. Let me tell you why. And we do it every day.
And frequently we would admit to the critical care unit. We would admit to telemetry. We would admit to the hospital. But with an understanding of palliative medicine and end-of-life care, the most appropriate place for these patients is possibly not in critical care, but on the regular hospital floor. Or possibly not even in the hospital, but in hospice. And possibly not in-hospital hospice, but at-home hospice.
Huge, huge dollars. EPM : And what about patient satisfaction? Somebody comes in and they have heart failure — we do a full resuscitation and get them better. They go to the intensive care unit. But let me tell you about palliative care. I get letters every day from our patients, communicating how much they appreciate what we do. Rosenberg : Exactly right. I am understanding their goals. Local hospice programs, especially those with inpatient hospice facilities that need daily physician coverage, might have part-time staff positions, which could be a great moonlighting opportunity for hospitalists and a way to learn a lot very quickly.
It can be some of the most rewarding work you can possibly do—especially when you have the time and training to do it well for some of the most challenging of patients and families. Storey recommends that hospitalists join AAHPM, use its professional materials, attend its annual meetings, and, if they feel a calling, consider fellowship training as the next big step.
I have heard of places that were having trouble recruiting palliative care physicians but were willing to sponsor a hospitalist to go and do a fellowship, supplementing their salary as an incentive—and a reasonable one—for a hospitalist interested in making a career move. He says that palliative care, like hospital medicine, has been a significant value-add in many hospitals and health systems. Pantilat says. Pantilat says it puts plans in place for patients to get the right services for the post-discharge period and for responding to anticipated problems like chest pain.
Valerie Phillips was diagnosed with stage IV breast cancer in and is a shining example of the difference a palliative care consultation can make. After she was diagnosed, the Austin, Texas, native continued to work and enjoy a relatively normal life.
But when the disease metastasized to her hip, she began to take opioid analgesics for the pain. Phillips says she felt foolish when she ended up in the ED, profoundly uncomfortable from a four-day impaction due to the analgesic and oral cancer drugs.
Upon admission, a hospitalist referred Phillips for an inpatient palliative care consultation with Stephen Bekanich, MD, a former hospitalist who now co-directs Seton Palliative Care for the Seton Health System in Austin. He found a way for me to better navigate the healthcare system, carrying all of that information in his head.
I trusted him—and it worked. Bekanich as an outpatient. Phillips says hospitalists should focus on the connection between disease treatment and the quality of life palliative care affords. Patients should be able to count on somebody who can take us by the hand and make the whole process as painless—and worry-free—as possible.
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