Thursday, July 29, 2010

What IS it you do?

Being interested in the field of hospice and palliative medicine for a solid 10 years now, there are times when I forget that not everyone knows what I'm talking about when I mention my career. Granted these aren't ever very long times, because what I've found is that, unfortunately, very few people actually DO have an idea of what this field of medicine offers. Usually the immediate question I'm asked when I tell someone what I do is, "what's that?" My immediate instinct is to say, "only the best and coolest field of medicine ever..." But more often I'm able to offer what has almost become my "elevator speech" giving a brief overview of what it means, and what those of us in the field can do for patients, for families, and sometimes as importantly, for other physicians (and all members of health care teams).
Previously I've posted this in an attempt to offer a bit more info.


In a recent issue of The New Yorker, Dr. Atul Gawande, a surgeon and writer, explored the question, "what IS palliative care?" While some of us might argue that he gives a somewhat narrow definition and explanation, still very much focused on the "hospice" side and less so on the ever-developing and expanding true "palliative care" side, at least he gives something. 
If you are reading this and have a background in medicine, chances are you realize how amazing it is that a surgeon would even take on this kind of question, much less write an informative and self-reflecting article about our field. More amazing, he provides, via an explanation provided to him by a hospice nurse, the following near-perfect succinct explanation for what we do:



The difference between standard medical care and hospice is not the difference between treating and doing nothing... The difference was in your priorities. In ordinary medicine, the goal is to extend life. We’ll sacrifice the quality of your existence now—by performing surgery, providing chemotherapy, putting you in intensive care—for the chance of gaining time later. Hospice deploys nurses, doctors, and social workers to help people with a fatal illness have the fullest possible lives right now. That means focusing on objectives like freedom from pain and discomfort, or maintaining mental awareness for as long as possible, or getting out with family once in a while. Hospice and palliative-care specialists aren’t much concerned about whether that makes people’s lives longer or shorter.
Entire article can be viewed here



The article itself provides stories of several patients and their experiences with palliative medicine and hospice, and also of a patient who did not have these services during her battle with cancer. Dr. Gawande paints a picture for us to look at, situations in which we may find ourselves - both as patients and as doctors - and reflect on where we would likely find ourselves in that tableau. I would encourage you to read the article, and consider it for yourself - where would you find yourself in this story? How would you deal with this situation in your own life, your own practice? Why?


Reflecting on these questions is far from easy, even pushing the border of being a scary and painful. The hard and fast fact, though, is that all of us are going to die. Maybe sooner, maybe later. Maybe quickly, maybe slowly. It might be an event we see forming on the horizon like a summer thunderhead, have time to prepare for, time to take cover, time to gather those things precious to us and keep them safer from the storm. It might, literally, hit you like a Mack truck, you never saw it coming.


Although we don't know how each of us will die, we still have control over aspects of our deaths. More importantly, we have control of the life before the death. Years before, months before, days before, hours before. If you take the time to read Dr. Gawande's article, you'll see examples of the many aspects of control individuals can maintain in regard to their deaths. Think about your own for awhile. Write down your thoughts and potential plans and wishes for how you would like to handle these events.
Medical people, think about how you interact with your patients and their families. Is it different from how you would interact with your own family members? Different from how you would hope to have your physician speak to you, shield you, or expose you?


I've done a bit of my own reflecting and the process continues daily. Every time I see a patient or hear about a patient facing a serious diagnosis,  the question in my mind, "what would I do?" is present. It is a question being asked of my physician self and also my non-physician self. What would I do as the doctor? What would I do as the patient? I hope I never stop asking this question, to either of my selves.




Again, a link to the original article
http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande?currentPage=4#ixzz0v5hNOtNg

1 comment:

Elizabeth Frick said...

I'll admit that I googled "palliative" care when I read that was your field, many months ago when I found your blog. I love the excerpt from the article that you posted here, and I've bookmarked the rest of it to read later.

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