Blog | Thursday, January 15, 2015

How and when to call palliative care


Did I tell you that I was a big fan of palliative care? Palliative care started around 15 years ago at the VA where I worked. We saw the service evolve. We saw how the palliative care approach improved the quality of both life and death.

Many physicians have not yet accepted or at least understood palliative care. Many physicians use some palliative care principles and believe palliative care is superfluous. My experience is quite different. In the two hospitals where I have worked with palliative care, our patients receive a team approach to quality of life. The palliative care team designs a program for the patient and the family.

Few physicians develop the skills of discussing advance directives and goals of care that our palliative care teams have developed. Few physicians have the time for the family meetings that often help achieve patient centered goals.

Too often we see palliative care called too late. Palliative care does not equal hospice. Sometimes that involve hospice, but that is a separate and important approach.

Many physicians think of palliative care for cancer patients, but we've seen great results with severe systolic heart failure, chronic obstructive pulmonary disorder, cirrhosis and chronic kidney disease stage 4 or 5. We help our patients and their families when we involve palliative care earlier rather than later.

I have developed a standard way to introduce the concept to patients. The students and residents find this introduction useful.

When we suggest a palliative care consult, we make a distinction between treating the disease and treating the person. We often explain that we have no major options for the disease process but that does not mean we cannot make each day as positive as possible. We explain that the palliative care physician and team will focus on addressing their symptoms and them as a person who has a disease or several diseases. This introduction makes the palliative care team's job much easier. They need a positive introduction.

Patients fear abandonment. Patients dislike discomfort in many dimensions. Palliative care addresses these issues, helps the patient and family develop clear plans for improving every day and eventually approaching a dignified ending.

Hooray for the palliative care movement!

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.