Jason A. Webb, MD – Inspiring Hospice and Palliative Medicine Leaders Under 40

This post is from one of the Inspiring Hospice and Palliative Medicine Leaders Under 40. Jason A. Webb, 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 am fortunate at Duke University to have many clinicians who have influenced my work and trajectory into hospice and palliative medicine, and two clinicians and educators stand out: Dr. Anthony “Tony” Galanos and Dr. Harold “Harry” Goforth. During my training, I had the great fortune of rotating with Dr. Tony Galanos, or Dr. “G”, as all of his residents and colleagues refer to him. Dr. G is a master communicator, and through his tutelage, he has helped me develop a strong foundation in the skills needed to be a proficient and compassionate communicator. Dr. Goforth, who mentored me for two years during my combined internal medicine & psychiatry training, showed me how a clinician with a focus on psychosomatic medicine could be an invaluable resource for patients with a palliative care need and co-morbid mental illness. I learned nearly everything I know about pain and symptom management from a biopsychosocial perspective from Dr. Goforth.

Where do you see yourself in 5 years?
I am currently developing a career that has three primary elements: clinical work, medical education, and global health. In the next five years it is my hope to continue to cultivate my development as a strong HPM clinician, with a growing focus on developing an integrated psycho-oncology and palliative care clinic. In my educational role, it is my hope in the next 5 years to transition into further leadership roles in medical education, with a goal of becoming a HPM fellowship training program director. Finally, I have been fortunate enough to travel to Kenya for two global health expeditions focused on providing palliative care. I sincerely hope to further develop clinical and educational programs in Sub-Saharan Africa to advance the care of cancer patients with severely unmet pain and symptom management needs.

What is the best advice you have ever received?
The best advice I have ever received came from one of my global health mentors Dr. G. Ralph Corey, and it had nothing to do with medicine, but rather was advice in fatherhood. During my chief residency my wife and I were expecting our first child and during a mentorship meeting Dr. Corey said, “Just remember, being a father takes patience, and that there is no such thing as a bad child, only impatient parents.” His advice has helped me through long nights of fatherhood, and I have used this advice more than I know as a palliative care clinician. It has helped me better understand as well, that “there is no such thing as a bad patient, only impatient doctors.”

Gordon Wood, MD MSCI FAAHPM – Inspiring Hospice and Palliative Medicine Leaders Under 40

This post is from one of the Inspiring Hospice and Palliative Medicine Leaders Under 40. Gordon Wood, MD MSCI FAAHPM, 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 career has been shaped so significantly by mentors that it is impossible to name just one. My interest in palliative care grew out of the opportunity to work with Dr. Stephen McPhee while doing my medicine residency at University of California, San Francisco. I had the good fortune of doing an elective rotation in palliative care with him and got to see him read poetry during family meetings to capture the emotion at hand. It was a profound experience that changed the direction of my career. I then went to Northwestern for my Palliative Medicine fellowship where I worked with Dr. Joshua Hauser and Dr. Michael Preodor in the Education in Palliative and End-of-Life Care (EPEC) Project, first as an attendee then as a teacher. These experiences and relationships led to a decision to change my focus from research to medical education. At Northwestern, I also worked with Korey Eckley, LCSW who taught me the power and joy of working in an interdisciplinary team. During my fellowship, I attended OncoTalk where I met Dr. Bob Arnold. The experience there and my relationship with Bob, with whom I would later work as faculty, developed my interest in communication skills training which continues to be the focus of my academic work. Finally, my relationship with Dr. Martha Twaddle has brought me to my current position where I am able to continue my work in communication skills training in both the academic setting of Northwestern and at Midwest CareCenter, a community hospice.

Where do you see yourself in 5 years?
I anticipate many changes and developments within the next five years. First of all, the palliative care program I direct at Northwestern Medicine Lake Forest Hospital will have moved to the new replacement hospital, which is scheduled to complete construction in 2017. This will come with new trainees, including a family medicine residency. I am fortunate to have the support of Midwest CareCenter and the Martha L. Twaddle Chair in Palliative Medicine, which will allow me the opportunity to develop educational programs for the learners at this new hospital as well as for Midwest staff and our community. In five years, we should also be wrapping up the “Preference-Aligned Communication and Treatment (PACT)” Project, a 4.5 year project scheduled to begin in the Spring of 2015 which will implement and analyze an advance care planning intervention at more than 20 Illinois hospitals and their post-acute partners. I anticipate this project will inform future proposals centered on team communication training. In five years, I also hope to be continuing to work with VitalTalk as we come to the end of our 5-year goal of providing communication skills training to 11,500 clinicians. By that time, we at the Education in Palliative and End-of-Life Care (EPEC) project anticipate having an updated core curriculum as well as new specialist and international curricula. Finally, I hope to be planning a wonderful celebration for my 10-year anniversary with my wife along with my two daughters, who will be 8 and 5 by that time.

What is the best advice you have ever received?
The best advice I ever received was my fellowship program director, Jamie von Roenn, suggesting I attend OncoTalk. I was thrilled about the opportunity for an all-expenses-paid week in Aspen, however, I became considerably less excited when I found out that the week would be spent doing role-play. What I experienced at OncoTalk, however, was fundamentally different from any role-play I had done before. It felt real and safe, yet challenging, and, to my amazement, actually became fun. I learned how to be a better observer of communication, breaking conversations into discrete elements, connecting causes and effects. It started to feel more like working in a lab, bouncing ideas off of really smart and insightful colleagues and trying out new things. It was exciting and became the focus of my academic career. Now, through a program known as VitalTalk, I am now fortunate to teach alongside the people who were my teachers during that first trip to Aspen.

In reflecting on the advice to attend OncoTalk, I think it was not only the concrete experience of attending the conference that made the advice powerful. It was also the suggestion that pushing yourself outside of your comfort zone to try something new can help you grow in significant and sometimes surprising ways. I have since tried to remember this when confronted with opportunities that seem different or daunting and it has moved my career in exciting directions I never would have anticipated.

Lindy Landzaat, DO – Inspiring Hospice and Palliative Medicine Leaders Under 40

This post is from one of the Inspiring Hospice and Palliative Medicine Leaders Under 40. Lindy Landzaat, DO, 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. This 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?
I believe in having multiple mentors for different things. I’m fortunately to have benefitted from the wisdom of many mentors starting from my internship. Two individuals stand out for having most influenced my work. First, Dr. Christian Sinclair who allowed me to rotate as a visiting resident and encouraged my involvement with AAHPM, has been a critical mentor. Dr. Sinclair helped mentor me in developing presentation skills, broaden my use of resources, and continues to help mentor my career development. Dr. Karin Porter-Williamson has been a crucial mentor in these first 5 years as junior faculty helping me grow both as a clinician and as an educator. She is skilled in bedside patient care, understanding palliative care systems development, and overall a great advisor and support. Dr. Porter-Williamson was able to help steer me down the path of medical education even before I could see that path for myself. It’s been fulfilling and I remain thankful for her guidance. Both of these visionary individuals founded and served as the previous fellowship program directors for the KU fellowship that I’m fortunate to now direct. To Dr. Sinclair and Dr. Porter-Williamson, as well as the many influential mentors I’ve had, I remain exceptionally grateful.

Where do you see yourself in 5 years?
I see myself as an associate professor at KU, continuing to grow and enhance our fellowship program. I enjoy interacting with a variety of learners at different levels and will continue to teach. I strive to make meaningful contributions to palliative care medical education, and a variety of clinical areas of interest including palliative pulmonary hypertension, palliative wound care, legacy work. Five years from now, my children will be 7 and 9, and my motherhood mission statement will remain, to be “loving and effective.”

What is the best advice you have ever received?
During my fellowship, I was always impressed by one of my psychosocial faculty member’s ability to analyze and make sense of chaotic situations-ones that could draw you in and quickly become all consuming. My faculty had an ability to step back, take the big picture, reflect on it dispassionately and from all angles, and in such a way that could yield productive outcomes. When I asked, “how do you do THAT?” The faculty member shared with me a resource called the Landmark Education Forum. It was a 3 day course that I eventually attended and it helped me understand my patients and families better, be a more effective clinician, and it offered me insight into personal areas that were limiting me; insight that I never would have gained otherwise. This remains some of the most life changing advice I’ve ever received and I’m thankful each day for it.

Patrick White, MD – Inspiring Hospice and Palliative Medicine Leaders Under 40

This post is from one of the Inspiring Hospice and Palliative Medicine Leaders Under 40. Patrick White, 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. Each 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?

The two most important influences in my career in hospice and palliative are Bob Arnold and Rudolph Navari. Dr. Navari introduced me to hospice and demonstrated the importance of incorporating palliative care techniques into his own oncology practice to provide his patients with the best quality of life possible. As an expert in antiemetic therapy, he taught me the importance of evidence-based symptom management and fostered my interest in academic medicine. Bob Arnold has been invaluable to my growth in the hospice field. He has been an amazing role-model and mentor who has provided me with many unique opportunities including participation in an NIH training grant, state-of-the-art training in communications, and the opportunity to help lead one of the best academic hospices in the country. This paragraph cannot do justice to how much I have learned from Bob during the hundreds of hours we have spent in mentoring meetings. I also think that one of the aspects of hospice and palliative care that differentiates us from other fields, is that our most distinguished leaders are so altruistic with their time. In addition to Drs. Rudolph and Navari, I have been very grateful to have received help from many other experts, including Drs. Janet Bull and Jean Kutner. Finally, I must acknowledge much of my clinical expertise has benefitted from the experience of hundreds of extremely patient and dedicated nurses at each of the centers where I have trained.

Where do you see yourself in 5 years?

I hope to be the Chief Medical Officer at an academic hospice that is a leader in integrating hospice and palliative medicine throughout an entire health system. The current delivery of end-of-life care can be so fragmented that patients and caregivers lack the support they deserve. I hope to be a leader in a system that embraces the need to build a seamless continuum of care, where providers work collaboratively further upstream to provide patients and caregivers with the knowledge, support, and resources they need. I hope my research background will enable me to demonstrate with data, the outcomes that a health system leadership team will value in promoting better integration of hospice and palliative care. I would love to find creative ways to better support caregivers and work with the Academy to change the way we view dying in America.

What is the best advice you have ever received?

I think the best advice came from my colleague and friend, Dr. Christopher Hughes. While I was trying to learn more about management, he paraphrased Paul O’Neil, who said “An organization with the potential for greatness must have each employee answer three questions: 1) Did they get treated with dignity and respect by every employee they encountered; 2) Were they given the knowledge, tools, and support they needed to make a meaningful contribution at work; and 3) Did somebody notice their contribution.” In hospice, it can be easy to forget what a huge contribution each nurse, certified nursing assistant, chaplain, and social worker makes to the organization and clients, daily. Our goal and challenge is to create an organization where the majority of our team can answer “yes” to these questions every day.

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

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

Special Article

Measuring What Matters: Top-Ranked Quality Indicators for Hospice and Palliative Care from the American Academy of Hospice and Palliative Medicine and Hospice and Palliative Nurses Association
Sydney Morss Dy, Kasey Kiley, Katherine Ast, Dale Lupu, Sally A. Norton, Susan C. McMillan, Keela Herr, Joseph D. Rotella, and David J. Casarett

Original Articles

Apoyo con Cariño: A Pilot Randomized Controlled Trial of a Patient Navigator Intervention to Improve Palliative Care Outcomes for Latinos With Serious Illness
Stacy Fischer, Lilia Cervantes, Regina M. Fink, and Jean S. Kutner

Measuring End-of-Life Care and Outcomes in Residential Care/Assisted Living and Nursing Homes
Sheryl Zimmerman, Lauren Cohen, Jenny van der Steen, David Reed, Mirjam C. van Soest-Poortvliet, Laura C. Hanson, and Philip D. Sloane

Patient Characteristics Associated With Prognostic Awareness: A Study of a Canadian Palliative Care Population Using the InterRAI Palliative Care Instrument
Kathryn Fisher, Hsien Seow, Joachim Cohen, Anja Declercq, Shannon Freeman, and Dawn M. Guthrie

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

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

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

Avoidable and Unavoidable Visits to the Emergency Department Among Patients With Advanced Cancer Receiving Outpatient Palliative Care
Marvin Omar Delgado-Guay, Yu Jung Kim, Seong Hoon Shin, Gary Chisholm, Janet Williams, Julio Allo, and Eduardo Bruera

What’s Different About Patients With Hematologic Malignancies? A Retrospective Cohort Study of Cancer Patients Referred to a Hospice Research Network
Thomas W. LeBlanc, Amy P. Abernethy, and David J. Casarett

Hospital End-of-Life Treatment Intensity Among Cancer and Non-Cancer Cohorts
Amber E. Barnato, Elan D. Cohen, Keili A. Mistovich, and Chung-Chou H. Chang

Predictors of Thirst in Intensive Care Unit Patients
Nancy A. Stotts, Shoshana R. Arai, Bruce A. Cooper, Judith E. Nelson, and Kathleen A. Puntillo

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

Why am I taking the HMDCB certification exam?

I have completed my application, paid my fee, scheduled my exam, and now I am beginning to study! So why am I doing this?

I have been in Hospice and Palliative Medicine for almost 30 years. I am a fellow and past president of the AAHPM. I am a founding member of the Academy, and I have my own palliative care company employing over 25 physicians, with two new contracts. How could I possibly benefit from getting this certification? I have talked with many people over the last two years who may have different credentials but do have the same question.

Hospice and Palliative Medicine is a very young field. Its entire existence fits within my career, and I am nowhere near ready to retire. In its short history, HPM has become a subspecialty of medicine and has a seat with the big boys of medicine. One of the consequences of this is that the board certification now requires a fellowship. There are only about 250 training positions in the country, and as a general rule, the only people that do fellowships are young physicians fresh out of training. Many of us who do hospice medicine are neither young nor fresh out of training, and are unlikely to stop our current activities to do a fellowship even if there were adequate physicians.

As of last count, there are over 5800 hospice programs in the country, and I believe a similar number of declared palliative medicine programs. Many physicians don’t consider this, but there are more board certified HPM physicians now than there are likely to ever be in the future. This is due to the fact that the large majority of physicians who are board certified, qualified for that certification based on practice experience, not fellowship training.

In addition to these workforce considerations, the regulatory and administrative demands on hospice physicians are constantly growing. Gone are the days where hospices could have their medical directors “sit down, shut up, and sign”. The hospices need physicians that are competent not only in good palliative medicine, but that also know how to provide for these regulatory and administrative needs.

Here enters the need for a certification that a physician can deliver these goods. This certification never intends to be an ABMS/AOA board specialty, and therefore will never require a fellowship. A physician can qualify to take the exam if they have had a fellowship, but they can also qualify now and forever, by practice experience. This certification also focuses very heavily on hospice and not the broader world of non-hospice palliative medicine. We fully anticipate that this will be the credential of value to the hospice industry as we go forward.

I don’t believe that getting this certification will change or enhance my professional life at this point in my career. I do believe that this certification is very important to the world of hospice medicine. This young profession needs all of us to step up to provide this very important credentialing foundation to the work that we do. If you, like me, see what you do as something more than a job, then I would like to extend a personal challenge for you to look beyond the personal gains, and assist in getting the momentum behind this certification.

Submitted by: David M. McGrew, MD FAAHPM

HMDCB Certification Discount at Assembly

If you missed the early application deadline to sit for the HMDCB exam, don’t worry! Attendees of AAHPM’s Assembly and virtual assembly will receive a discount code to waive the $250 late fee. Simply stop by the HMDCB booth, #418, and ask for the code.

Hospice medical directors are a diverse group of professionals, many of whom have followed varied career paths leading to their affiliation with hospice programs. Thus, some may be unable or choose not to undertake full hospice and palliative medicine subspecialty board certification through ABMS or AOA. These same physicians, however, do desire a formal recognition process that will validate their commitment and provide a solid foundation for their work as hospice medical directors.

By applying to become Hospice Medical Director Certified® (HMDC®), physicians can achieve profession recognition and credibility, increase your professional marketability, and enhance the team approach that is essential to successful hospice care.

Eligibility

    To earn the HMDC credential, licensed physicians from the United States and Canada must

  • Demonstrate 400 hours of broad hospice-related activities during the past 5 years
  • Conform to HMDCB Code of Professional Conduct
  • Meeting ONE of the follow 3 eligibility pathways:
    • Practice Pathway: 2 years of work experience in a hospice setting:
    • Certification Pathway: Current certification in hospice and palliative medicine (HPM) through ABMS, AOA, or ABHPM:
    • Training Pathway: Successful completion of an HPM-accredited fellowship training program:
  • Pass a certification exam.

Learn more about HMDCB at www.HMDCB.org. Be sure to visit HMDCB in booth #418 at Assembly to receive your discount card!

Thomas LeBlanc, MD MA – Inspiring Hospice and Palliative Medicine Leaders Under 40

This post is from one of the Inspiring Hospice and Palliative Medicine Leaders Under 40. Thomas LeBlanc, MD MA 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. Each 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’ve been incredibly fortunate to work with a remarkable team of palliative care researchers and clinicians here at Duke over the last decade. There are too many amazing people to mention, but among the most influential are Amy Abernethy, James Tulsky, Karen Steinhauser, and Tony Galanos. Amy is busier and more productive than anyone I know, yet she’s always incredibly generous with her time, resources, and mentorship; we’ve been working together since I was a medical student in 2005, and so many of the opportunities and success I’ve had are because of her. I worked in James’ clinic when I was a 3rd year medical student, and that’s when I first came to understand the incredible power of good communication. Seeing his masterful communication skills in action motivated me to cultivate some of those skills too, and it has made me a better doctor in the end. Plus, without his guidance in all things about life, who knows where I’d be! And without Karen’s help, I doubt I would have gotten my first grant. She met with me at a coffee shop during a day off, and very gently helped me realize how many mistakes I had made in my writing. With that useful feedback, the grant was markedly improved and it got funded, and this success has really helped launch my research in palliative care for patients with blood cancers! Last but certainly not least, I’ve been fortunate to work with Tony Galanos several times in recent years, especially during my HPM fellowship. His passion for helping patients and families is truly remarkable, and his prowess doing so is inspirational. He has shown me first-hand what it means to truly palliate.

Where do you see yourself in 5 years?
In 5 years I hope I’m still doing what I do now: caring for patients with blood cancers, and doing research that seeks to improve their quality of life, even in cases where we cannot cure. When I look back in 5 years, I hope to be able to say that I’ve made a difference in the lives of the patients and families I’ve cared for, and that the research I’ve done has helped move us towards a place where we can better serve their needs. I also hope I can say that we’re more sophisticated in how we deliver palliative care to patients with blood cancers such that we’re doing it better, and much more often, even alongside active cancer treatment.

What is the best advice you have ever received?
One of my favorite teachers used to post inspirational quotes on the walls of the classroom. The one that always stuck with me was this: “You are what you take time to become.” It seemed true back then, and it continues to ring true in my lived experiences since. Sometimes we’re fortunate in life to be in the right place at the right time, but mostly we end up where we are because of each step we’ve taken along the way. I strive to make each step count, and to ensure it’s a firm-footed one that heads in the right direction.

Help Spread a Unified & Positive Hospice & Palliative Care Message

Want to introduce palliative care and hospice as a positive kind of healthcare to patients and other healthcare providers? By Rebecca Goett MD

American Academy of Hospice and Palliative Medicine (AAHPM) is highlighting our strength with our palliative power and hospice hero campaign. As palliative and hospice providers, promoting our field as a harmonized discipline filled with growing resources is important. AAHPM wants to emphasize how palliative care and/or hospice empowers patients in caring for their life-limiting illness.

In order to promote our strength, we want you to share pictures, poems, video, audio, or quotes exemplifying hospice and palliative medicine. Submit an image, poem, or song that best portrays the power of palliative care or describe your hospice hero using the Twitter hashtags #pallpower or #hospicehero. Tweet at @AAHPM to communicate your story! Participants may also use AAHPM’s Facebook page to post your #pallpower or #hospicehero moment. No Twitter of Facebook? No problem. You can share by stopping by the AAHPM Resource Center at the assembly to convey a story, poem, photo, or video describing your moment.

The two submissions with the most impact selected by the AAHPM external awareness committee will receive a signed book by Dr. Atul Gawaude or Chester Elton. Only tweets, Facebook posts and AAHPM Resource Center submissions received during the AAHPM &HPNA Annual Assembly (Wednesday, February 25th starting at 7am through Saturday, February 28th ending at 2pm) will be eligible for the contest. We encourage everyone to continue tweeting their personal expressions of #pallpower and #hospicehero throughout the year. With this contest, we begin the campaign to reinforce palliative care and hospice as an affirmative empowering type of healthcare.

To assist in enhancing our solidarity, AAHPM is selling palliative power and hospice hero socks at the AAHPM Resource Center for $15 to help spread awareness. Check out our photos. Wear your #pallpower or #hospicehero socks Saturday for #hpmsox at the annual assembly.

Recap:
Tweet, Facebook, or stop by our booth at the AAHPM & HPNA Annual Assembly and share what #pallpower or #hospicehero means to you!

Buy and wear your socks for on Saturday for #hpmsox!

Fine print: Those participants who include @AAHPM in the tweet are giving permission to AAHPM to display their tweet/ media (picture, audio, video, poem etc). Only current AAHPM members will be eligible for the prizes.