Joseph Milano, MD – Inspiring Hospice and Palliative Medicine Leaders Under 40

This post is from one of the Inspiring Hospice and Palliative Medicine Leaders Under 40. Joseph Milano, MD, was selected based on his involvement in AAHPM, educating others about hospice and palliative medicine, participation in charitable work, and mentoring of students or residents. The honoree was then asked who inspired him over the course of his career. We are sharing some of his answers in this post. Check back regularly for posts from other leaders.

Who has most influenced your work in hospice and palliative medicine and what impact has he or she had?
During my short career as physician, and an advocate of the fragile population, there is one person who has overwhelmingly pushed me to new heights of positive impact. This individual has not only influenced the direction of my career but has shaped my perception of how we treat patient and families during times of crisis. Her name is Susan Degnan. Susan was an employee at Huntington hospital for nearly a half of a century. The role of a social worker fit her best, and fortunately for me that role was the greatest impression on my career.

Susan was not only my team-mate, but also was a mentor. She released her knowledge and wisdom very easily. She never held back to offer a compassionate answer or solution but actually leaned forward by offering more of herself. It was an absolute honor and privilege to work alongside an individual that appreciated the very granular pieces of human interaction. It is with great honor that I am able to recognize Susan Degnan as the individual that has impacted me the most.

Where do you see yourself in 5 years?
Recently, the honor and privilege came to me by being given the opportunity to medically direct the house call program for the North Shore-LIJ health system. Currently I am very excited about developing and spreading the program beyond its current capacity. This journey for our team will be very exciting and full of new experiences.

The journey will likely take me years to feel that the groundwork which is being laid, and the efforts which will be accomplished, will set a foundation for a community and for the health system.

Therefore, within the next few years, I see myself with in this role developing, learning, and achieving a better understanding of what our community needs when dealing with our fragile population.

What is the best advice you have ever received?

Advice comes from many directions and normally advice that does come pertains to only what you’re going through at the time. Keeping this in mind, if the information given to you makes sense, reasonable, and realistic I accept the advice and use it accordingly.

The one specific example of a life lesson was from the same person that influenced my career the most my former social worker Susan Degnan. Susan, always reflected, never presumed, and never judged quickly. It was because of the way that she approached every difficult situation; she was able to leave with me an impression that was life lasting.

The best advice that she ever came to me with was not a secret, it was not even her own words. The advice was from a well- known prayer. That prayer was called the Serenity prayer. The words within that prayer gave me comfort and a deeper understanding of why things do not always work out the way you would wish. As a young physician that was difficult to infuse with in my practice. The more I remembered the words the easier it was to practice the understanding.

So again, I owe the best advice given to me within my career to Mrs. Susan Degnan.

Lori Earnshaw, MD – Inspiring Hospice and Palliative Medicine Leaders Under 40

This post is from one of the Inspiring Hospice and Palliative Medicine Leaders Under 40. Lori Earnshaw, MD, was selected based on her involvement in AAHPM, educating others about hospice and palliative medicine, participation in charitable work, and mentoring of students or residents. The honoree was then asked who inspired her over the course of her career. We are sharing some of her answers in this post. Check back regularly for posts from other leaders.

Who has most influenced your work in hospice and palliative medicine and what impact has he or she had?
Dr. Joe Rotella introduced me to the field and has been a constant source of support and wisdom. He brings a humanistic approach to all of his relationships, and his message of compassion keeps me connected with my original motivation for becoming a physician.

I must also include my first boss, Dr. Ann Shaw, who has always nurtured me toward realizing my full potential. As a woman in academic medicine, I try to model myself after her example.

Where do you see yourself in 5 years?
I envision myself continuing to improve patient care through education of practicing health care professionals, inter-professional students, and the broader community. I hope to lead the integration of palliative care throughout the statewide health care system in order to bring best palliative care practices to patients and families throughout the state of Kentucky.

What is the best advice you have ever received?
My mother introduced me to the writings of Joseph Campbell while I was in high school, and I try to “follow my bliss” as I make important decisions. When I align myself with people and projects that highlight my values, my happiness and fulfillment make a positive impact on those around me.

Jeff Klick, MD – Inspiring Hospice and Palliative Medicine Leaders Under 40

This post is from one of the Inspiring Hospice and Palliative Medicine Leaders Under 40. Jeff Klick, MD, was selected based on his involvement in AAHPM, educating others about hospice and palliative medicine, participation in charitable work, and mentoring of students or residents. The honoree was then asked who inspired him over the course of his career. We are sharing some of his answers in this post. Check back regularly for posts from other leaders.

Who has most influenced your work in hospice and palliative medicine and what impact has he or she had?
I have always been drawn to helping children and families in distress. Early in my career, I formed relationships with amazing Pediatric Hospice and Palliative Care (P-HPC) clinicians Dr. Chris Feudtner, Dr. Tammy Kang, and Gina Santucci, PNP at Children’s Hospital of Philadelphia (CHOP). At that time, P-HPC was an emerging field and I found myself drawn to every aspect of it. Managing suffering in all of its forms was the core of why I became a doctor. Tammy, Chris, and Gina taught me how to do this as a professional within a team.

I found myself with tremendous mentorship from leaders in Pediatrics such as Drs. Lou Bell and Steven Ludwig at CHOP. They showed me how to patient in following my passion and how to be a leader without taking myself too seriously.

My first major contribution came a year into my career when my team started the third Pediatric-HPM fellowship in the country at CHOP. During this process I formed relationships with Drs. JoAnne Wolfe (P-HPC at Boston Children’s and Dana-Farber Cancer Institute) and Sarah Friebert (P-HPC at Akron Children’s). JoAnne and Sarah have provided mentorship, encouragement, and collaboration in many projects. They also provided a vision for career paths in academic pediatric hospice and palliative medicine.

I then attended the AAHPM Fellowship Summit where I formed relationships with Dr. Rodney Tucker (HPM at University of Alabama at Birmingham) and Sally Weir (at the time with AAHPM). They encouraged me to get engaged in AAHPM where I found my passion for developing communities and energy around specific ideas. AAHPM has provided a tremendous community for me, to which I am indebted.

I have been blessed to work with many leaders and wonderful people in HPM. From leaders in adult-focused HPM, such as Susan Block (Chair, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute) and Tammie Quest (Director, Palliative Care Center, Emory University); to my many friends and collaborators who make up the tremendous community of pediatric palliative care; to the leaders within the academy who create such a great collaborative environment to foster our field; to my team at CHOA which makes the real work of caring for kids possible and rewarding every day; to my former fellows who continue to teach me so much.

Each of these leaders proved instrumental in engaging me in leadership roles throughout my career. I have found myself with opportunity after opportunity to lead in a field that I am passionate about. Along the way, I have been influenced by many incredible people. I truly wish I had space to name them all.

In my mind, though, the greatest influence has always been the children and their families. It is their experiences, courage, and raw life stories which drive the passion in all of us. If you let them, they will all have a tremendous impact on your life.
They all taught me that leadership is about collaborative practice. If managing suffering is why I became a doctor, the joy of collaborative practice is why I became a leader. HPM offers me a place to practice both of these passions.

Where do you see yourself in 5 years?
Four years ago, I took on the task of creating a center of excellence in Pediatric Palliative Care at Children’s Healthcare of Atlanta and Emory University School of Medicine. I have been joined in that task by many tremendous clinicians—Nicolas Krawiecki, Khaliah Johnson, Erin Mullaney, Meghan Tracewski, and Maura Savage—each giving up a lot of themselves to join this vision of creating a center that can serve the state of Georgia and the Southeast region in improving the care for kids with serious illnesses. We have come a long way, affected countless lives, and developed a tremendous program, but we have big goals and a long way to go to meet them.

The next five years will be focused and dedicated to that vision (and being a good husband and dad). We will have to see where we go…

What is the best advice you have ever received?
This probably came early in life following a season of pee-wee football. After spending the whole year lobbying the coach to “just throw me the ball,” I got a special award…it was a bumper sticker that simply said “lighten up.”

In our clinical and programmatic work, we find ourselves in intense situations. In this field, we are very lucky to have many strong leaders who are excellent at solving problems and moving solutions forward. This fact, however, can significantly add to the intensity, as we are always focused on fixing things and not just being still. Being able to manage and cope with that intensity and to be calm in the craziness—to lighten up when it matters most—has proven to be an essential skill. I just wish it was always easy to do.

Highlights of the June Issue of the Journal of Pain and Symptom Management

Listed below are a few articles from the most recent issue of the journal:

Promoting Evidence in Practice

Acknowledging the Person in the Clinical Encounter: Whole Person Care for Patients and Clinicians Alike. Commentary on Chochinov et al.
Christina M. Puchalski and Najmeh Jafari

Original Articles

Eliciting Personhood Within Clinical Practice: Effects on Patients, Families and Health Care Providers
Harvey Max Chochinov, Susan McClement, Thomas Hack, Genevieve Thompson, Brenda Dufault, and Mike Harlos

Preoperative Breast Pain Predicts Persistent Breast Pain and Disability Following Breast Cancer Surgery
Dale J. Langford, Brian Schmidt, Jon D. Levine, Gary Abrams, Charles Elboim, Laura Esserman, Deborah Hamolsky, Judy Mastick, Steven M. Paul, Bruce Cooper, Kord Kober, Marylin Dodd, Laura Dunn, Bradley Aouizerat, and Christine Miaskowski

Massage, Music and Art Therapy in Hospice: Results of a National Survey
Aleksandra S. Dain, Elizabeth H. Bradley, Rosemary Hurzeler, and Melissa D. Aldridge

Trajectories of Symptom Occurrence and Severity from Before Through Five Months After Lung Cancer Surgery
Trine Oksholm, Tone Rustoen, Bruce Cooper, Steven M. Paul, Steinar Solberg, Kari Henriksen, Johny Steinar Kongerud, and Christine Miaskowski

To access the articles, you must subscribe to JPSM or be a member of the American Academy of Hospice and Palliative Medicine (AAHPM). For further information on the Academy, call 847.375.4712 or visit aahpm.org.

Submitted by: David J. Casarett, MD, MA, Senior Associate Editor, JPSM

Chicago-bound? What to Do and Where to Eat

Are you heading to Chicago to join AAHPM for the Summer Institute? Need ideas on what to do while you are here? Find out what locals have suggested below:

Attend the Chicago Air & Water Show, August 15-16 for the largest free admission air and water exhibition of its kind in the US. The show will feature daredevil thrills in the air and on the water with the Chicago Skyline as a background – a must-see event. Some other sites you’ll want to visit areNavy Pier or step out onto the Skydeck at Willis Tower. Check out one of the many great institutions Chicago has to offer: Art Institute of Chicago, Shedd Aquarium, The Field Museum, Museum of Science and Industry, Lincoln Park Zoo, Museum of Contemporary Photography, or Adler Planetarium and Wrigley Field. Enjoy the surroundings of one of the beautiful parks in the city including: Lincoln Park, Grant Park, Millennium Park, and Clarence F. Buckingham Memorial Fountain. Sign up for a tour through the Chicago Architecture Tours and visit iconic skyscrapers, elegant hotels or homes designed by Frank Lloyd Wright.
Chicago Traveler will supply you with many more ideas for your trip.

Do you have suggestions on where to eat? Submit suggestions in the comments. Some nearby options include:
Mercat a la Planxa – Tapas
McCormick & Schmick’s Seafood & Steaks
Buddy Guy’s Legends – Blues club with Cajun and Creole food
Acadia – Seasonal American
Lou Malnati’s Pizzeria

AAHPM Summer Institute
Designed with your professional development needs in mind, select the courses based on your career goals:
-AAHPM Leadership Forum: Ascend (August 16-18)
-Intensive for CEOs and CMOs: Building an Exceptional Physician/Executive Leadership Team (August 17)
-ICD-10 Boot Camp for Hospice and Palliative Care (August 17)
-Hospice Medical Director Conference (August 18-19)
Learn more and register at www.aahpm.org/SummerInstitute or call 847.375.4712.

Are You a Leader or a Jerk?

My Chief Medical Officer, Dr. Chris Hughes, and I have been discussing leadership and communication, as we promote the development of effective behavior in ourselves and in our staff. During a recent chat about one tome on the subject, “What Got You Here Won’t Get You There” by Dr. Marshall Goldsmith, Dr. Hughes succinctly summarized the book in four words: “Don’t be a jerk”.

This light-hearted comment holds great wisdom, and insight into the common pitfalls of leadership.
We all start out with similar traits on the leadership trajectory. Young leaders are typically really smart, personable, ambitious and happy to go above and beyond to do whatever it takes for the organization. Their amiability activates others. They get promoted.

With the power of position and the increasing pressures of leadership, many of these superstars go off the rails because of their way of relating to others; particularly in handling conflict, listening respectfully, problem-solving and maintaining their composure. In other words, they act like jerks. Stress can cause an otherwise perfectly lovely person to act like a jerk, and it is incompatible with effective leadership. Of course, the higher we rise in the workplace hierarchy, the less likely we are to receive honest feedback about how we treat others!
We are now in a highly scrutinized and regulated industry that requires our best efforts to both honor our mission and thrive in this environment

Under these highly intense and game-changing conditions, the jerk can emerge:

  • Use of power or status to win arguments and drive change
  • Insensitive or aloof persona
  • Poor frustration tolerance
  • Low insight into the impact of their style and behavior on others
  • Reliance on obsolete strengths; failure to adapt to changing conditions
  • Trail of hurt feelings among those in their wake

It is essential that leaders at all levels recognize the need for and develop leadership skills that will help us navigate the white water of healthcare reform and hospice’s transition into a mainstay of the healthcare continuum. The ability to engage and motivate employees during difficult conditions is a core competency. Vision and experience remain necessary, but are no longer sufficient.

Barbara Ivanko, CHPCA
President & CEO
Family Hospice and Palliative Care
Pittsburgh, PA

Find out how to develop and strengthen the key relationship between physician and executive leaders at this new one-day program on August 17 in Chicago. Learn the best strategies and most innovative tools to take your hospice leadership team to the next level at the Intensive for CEOs and CMOs: Building an Exceptional Physician/Executive Leadership Team. Learn more at www.aahpm.org/SummerInstitute.

Kate Lally, MD FACP – Inspiring Hospice and Palliative Medicine Leaders Under 40

This post is from one of the Inspiring Hospice and Palliative Medicine Leaders Under 40. Kate Lally, MD FACP, was selected based on her involvement in AAHPM, educating others about hospice and palliative medicine, participation in charitable work, and mentoring of students or residents. The honoree was then asked who inspired her over the course of her career. We are sharing some of her answers in this post. Check back regularly for posts from other leaders.

Who has most influenced your work in hospice and palliative medicine and what impact has he or she had?
Many people have, and continue to, influence my work. When I teach about having end-of-life conversations I often quote Dr. Nancy Angoff, a mentor of mine in medical school who specialized in treating patients with HIV. When I was in medical school, people were frequently dying from AIDS and Dr. Angoff helped young people navigate an illness that was ending their lives much too soon. In addition to Dr. Angoff, I also often cite a hospice nurse I used to work with, who taught me the language to speak with my patients about the harms vs benefits of various treatments. I was struggling to explain the studies showing the risks associated with tube feeds in a dementia patient to a daughter who was distraught over the imminent death of her father. She was very upset and accused me of starving him. The conversation was failing when the nurse approached and said “Dr. Lally stopped the tube feeds because I asked her to. He was drowning in them, they were going into his lungs and he couldn’t breathe. He is much more comfortable now.” Her approach was so clear and kind, that it made me re-think how I had these conversations. Just recently I worked with a psychiatrist who explained the terminal nature of Alzheimer’s to a family that was struggling with understanding the rapid decline of their mother in an incredibly compassionate and clear way. These people and more have influenced my work and help me get better every day.

Where do you see yourself in 5 years?
I love the field of palliative care. What I love most about it is the broad array of opportunities available to those of us who practice it. I am first and foremost a clinician, and when I go through difficult times at work it is always an encounter with a patient that reminds me how much I love what I do. I recently was able to work with a patient with dementia and agitation in an assisted living, our team had the opportunity to work with geriatric psychiatrist, geriatricians, the PCP, the patient and family and nurses at the assisted living to think though a good plan for this patient to manage his agitation, avoid a hospitalization and reassure his family. What is so exciting about palliative care is that we get to be at the forefront of changing models of care. We get to sit at the table with CEOs and administrators and help design programs to improve the care of our sickest patients in a system that we all know doesn’t serve our most vulnerable well. In the next 5 years I hope to continue to expand and improve my clinical work and continue to have the opportunity to innovate and change the system to provide better care to those who need it most. I hope to become known as an innovator in the field, someone who works across disciplines and specialties to improve end of life care for all out patients.

What is the best advice you have ever received?
I feel like at different points of my life I go around repeating different bits of advice that I have received. Most currently I have been considering something I heard on a documentary about particle-accelerators…

The secret to success is to be able to go from failure to failure with undiminished enthusiasm.

I have this idea that if you fail enough and learn from each of your failures you will get stronger and better with each attempt. From working with our patients to figure out a reasonable plan of care that may deviate from the norm, to working with insurance companies and health systems to think about how to revamp healthcare in a larger sense, our field is all about innovation. We need to make mistakes, learn from them, and try again. Maintaining a positive outlook can be tough at times, but I try to remind myself that it is all part of the process, and that we need to fail in order to succeed.

Arif Kamal, MD – Inspiring Hospice and Palliative Medicine Leaders Under 40

This post is from one of the Inspiring Hospice and Palliative Medicine Leaders Under 40. Arif Kamal, MD, was selected based on his involvement in AAHPM, educating others about hospice and palliative medicine, participation in charitable work, and mentoring of students or residents. The honoree was then asked who inspired him over the course of his career. We are sharing some of his answers in this post. Check back regularly for posts from other leaders.

Who has most influenced your work in hospice and palliative medicine and what impact has he or she had?
My work in Hospice and Palliative Medicine is most influenced by the memory of my mother. It was my experiences taking care of her that inspired me to shift my career towards this discipline, and it is her lasting memory and influence that keeps me passionate about improving the lives of others with serious illness and their loved ones. Secondly, Amy Abernethy, my longtime mentor and friend has shown me how to translate that passion and inspiration into meaningful research, effective leadership, and compassionate clinical care.

Where do you see yourself in 5 years?
In five years, I see myself furthering the quality of palliative care delivery across the discipline through research and leadership activities.

What is the best advice you have ever received?
My favorite advice is about the role of a leader – “The role of a leader is to define reality, and in the end say thank you. Otherwise, the leader is a servant” – Max Planck.

ICD-10 Program Focusing on Hospice and Palliative Care

Dear Education Colleagues,

Are you familiar with all the ICD-10 changes coming your way? Are you certain exactly where to find morphology codes? What has the 8-week rule regarding initial and subsequent MIs changed to? How does laterality effect your coding? How will you correctly code for symptom treatment? What about the management of terminal illnesses with related conditions? Discussions will include the significant advancements between ICD-9 and 10, the newly created complex guidelines encompassing codes, rules including Laterality, Encounters, Activity, and Place of Occurrence. The newly created ICD-10 structure accommodates both technological and medical advances and, allows for more flexibility with the highest level of specificity and clinical detail. New features include the relocation of the Neoplasm Table and why the Hypertension Table is no longer necessary.

We will answer your questions, address your concerns, and teach you the myriad of changes with respect to new laws and requirements in Hospice and Palliative Care at the ICD-10 Boot Camp for Hospice and Palliative Care.

October 1st is fast approaching, let us lead you to Your Success for ICD-10!

Jean Acevedo, LHRM CPC CHC CENTC
Acevedo Consulting Incorporated

Amy Frieman, MD – Inspiring Hospice and Palliative Medicine Leaders Under 40

This post is from one of the Inspiring Hospice and Palliative Medicine Leaders Under 40. Amy Frieman, MD, was selected based on her involvement in AAHPM, educating others about hospice and palliative medicine, participation in charitable work, and mentoring of students or residents. The honoree was then asked who inspired her over the course of her career. We are sharing some of her answers in this post. Check back regularly for posts from other leaders.

Who has most influenced your work in hospice and palliative medicine and what impact has he or she had?
Dr. David Muller, Dean of Medical Education for the Icahn School of Medicine at Mount Sinai, has most influenced my work, not only in hospice and palliative medicine, but as a physician. Dr. Muller was the Director of the Mount Sinai Visiting Doctors Program when I was a resident at Mount Sinai and later when I was an attending. I have had the amazing opportunity to call him both a mentor and a friend. Making house calls with Dr. Muller, I immediately understood that he was the type of physician that I would strive (and continue to strive) to become. He clearly recognized the person behind the list of medical diagnoses. He listened more than he spoke, and his presence in itself was a comfort to his patients and their families. As a resident, on one of my first home visits with Dr. Muller, I remember visiting a patient with dementia and spending the vast majority of the visit seated in the living room, speaking with the patient’s wife. Initially, I wondered where the patient was and when we would examine him. As Dr. Muller continued to provide support to the patient’s wife, I realized that this would be the most important part of the visit that day. This was the first time that I truly recognized that doctoring comes in many different forms. Dr. Muller also encouraged me to become involved with medical education and helped me to foster my interest in medical humanities.

Where do you see yourself in 5 years?
In five years, I see myself continuing to expand palliative care services at Meridian Health. While palliative care has become an important part of the culture of our inpatient and post-acute care facilities, I want to continue to work to build upon our outpatient palliative care services. I plan for our home-based palliative care program to continue to expand. In addition, I envision our office-based palliative care practice extending to multiple locations. As Meridian continues to actively address health care reform, my goal is for palliative care to be firmly entrenched within our system’s population health management initiatives, our accountable care organization (ACO) and our clinically integrated network. As a patient advocate, my vision is that in five years, the delivery of palliative care at Meridian will be seamless, and that all patients who would benefit from palliative care will have access to these services no matter where they are in the care continuum. In addition to continuing my work at Meridian, I plan to become more active on the statewide level in New Jersey, advocating for increased use of palliative care and hospice services for our vulnerable patient population.

What is the best advice you have ever received?
The best advice that I have ever received is to “choose to be happy.” Growing up, this was a message that I frequently heard from my parents. I believe it is even more pertinent to me as an adult, particularly now as a hospice and palliative medicine physician. Being surrounded by patients with serious and often terminal illness, I have tried to embrace this advice. I make a conscious effort to recognize all of the gifts that I have in my life every day, and to be grateful for each and every one of them. I look at my amazing family and friends, my good health that allows me to leave the hospital and go for a run, my rewarding career, and I know that I have been blessed in life. Rather than focusing on the negative and allowing myself to become discouraged by difficult issues, I try to choose to be happy. Though I am certainly not always successful in this mission, more often than not, I find that happiness is a mindset and a way of looking at life.