Monday, January 23, 2017
Palliative Care Is...
I wait intently as the board members rearrange themselves in their seats and look up expectantly. Silence. I wasn't going to let it be that easy. I repeat myself and pause again. This time a few tentative answers flutter up to the podium.
hospice...comfort care...end of life...giving up?
Now this is something I can work with. I clear my throat and smile broadly.
Palliative care is a philosophy.
I can't help but launch into a series of idioms. I talk of the difference between the forest and the trees. I invoke Osler's famous quote about how the great (palliative) physician treats the patient and not the disease. We talk of the sanctity of quality versus the expediency of quantity. I can see heads shaking in agreement now. The ideas are starting to sink in. I mention patient-centeredness and I can feel the the room stir. I talk of dignity. The goal is to face illness with the same dignity that we attempt to face health. The participants inhale and exhale with each word.
Palliative care is a skill set.
Palliative care is a consultative service just as a cardiology or nephrology. Board certified physicians in hospice and palliative care treat pain, nausea, anxiety, as well as a host of other symptoms. We also are skilled in advance disease planning. Counseling on end of life, and not so end of life care. Helping guide the decisions about code status and hospitalization, and timing and duration of care.
Palliative care is a team sport.
Nurses, social workers, chaplains, therapists, volunteers, and nursing assistants. Relieving pain and suffering is complex and multifaceted. It is not only a physician's domain. Each skills set brings it's own version of comfort to the suffering. But mistake me not, we all speak the same language. It is neither medicine nor religion. It's compassion.
Palliative care is not hospice.
In fact hospice is a small part of palliative care. If palliative care were a bus, hospice would be a few rows of seats in the front (or back). It is concomitant care of chronically ill patients coordinated with other specialties. One can continue any treatment they wish. Chemotherapy, surgery, hospitalization. And it is not a substitute for hospice. Hospice is a medicare benefit appropriate for up to the last six months of life for those who wish to discontinue curative treatments. It brings with it a host of services not otherwise covered by general palliative care.
Palliative care is important.
It is something you, your family, and your institution need to know about.
Posted by Jordan Grumet at 3:20 PM