I waited intently as the board members rearranged in their seats and look up expectantly. Silence. I wasn’t going to let it be that easy. I repeated myself and paused 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 could work with. I cleared 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. The ideas are starting to sink in. I mention patient-centeredness, and I can feel 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 and a host of other symptoms. We also are skilled in advanced disease planning, counseling on end of life and not so end-of-life care. We help guide the decisions about code status, hospitalization, timing and duration of care.
Palliative care is a team sport.
It takes a whole group: nurses, social workers, chaplains, therapists, volunteers and nursing assistants. Relieving pain and suffering is complex and multifaceted. It’s not just a physician’s domain. Each skill set brings its 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 covered by general palliative care.
Palliative care is important.
It is something you, your family and your institution need to know.
Jordan Grumet is an internal medicine physician who blogs at In My Humble Opinion. Watch his talk at dotMED 2013, Caring 2.0: Social Media and the Rise Of The Empathic Physician. He is the author of Five Moments: Short Works of Fiction and I Am Your Doctor: and This Is My Humble Opinion.
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