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Nidhi in Palliativecareland

by Nidhi Khosla, PhD, MPH

I woke bleary eyed at 4 am for my 4:30 am shuttle pick up on October 20, 2015. The shuttle would take me from Columbia, Missouri to St. Louis airport where I was supposed to catch a flight to Denver. At Denver, I would board a flight to Jackson Hole to attend the much awaited Kathleen Foley Palliative Care Retreat. As a junior investigator with a PhD in Public Health and research interests in reducing health disparities, I was looking forward to this golden opportunity.

The shuttle driver actually arrived at 4:15 am because he had several pickups. My fellow riders to St. Louis were clearly in some other time zone, chattering away in the darkness in English and what sounded like an Eastern-European language, over the 2-hr journey. Sleepless, I wondered if I might meet a fellow passenger on the Denver-Jackson Hole flight who was heading to the same retreat. When we landed at Jackson Hole, the marching band was conspicuous by its absence. Surely, a plane that arrived nearly full with luminaries of the palliative care world deserved a welcome from a marching band or a resounding 21 gun salute?

The retreat eventually started after the attendees had been coaxed to actually enter the hall rather than linger at the doorway over the ‘hellos’ and ‘great to see yous’. My eyes darted from name tag to name tag. They were all there! The names of the authors in my literature review folder concerning end of life and palliative care, had metamorphosed into actual humans who were walking and talking to each other around me. My literature review had miraculously come alive! The official welcome remarks revealed the wide diversity in attendees that included 3 JDs, 61 Medical Doctors/DOs, Doctors of Philosophy, Registered Nurses and Social Workers.

In the first presentation, I learned that high intensity end-of-life care was not unique to the United States, with other developed countries also providing aggressive care. The parallels to everyday behaviors such as ‘do you like vanilla or chocolate ice-cream?’ and the interesting experiments derived from Economics and Psychology generated several interesting ideas about advance care planning and how that might be encouraged. The presenter concluded that we need to build better advance directives and motivate patients to complete them, engage physicians and encourage them to overcome their tendency to procrastinate.

Over dinner, I sat with the AAHPM staff and scholarship/award winners and learned more about them and then crashed in a huge suite that had more doors than my apartment. The next morning started with an excellent breakfast and a very well-organized poster presentation. I think more meetings need to adopt this method of small-groups led by leaders. The groups moved systematically from poster to poster, thus creating a different kind of small-group learning.

The breakout groups offered a wide variety of learning themes. The first presentation in the group I attended focused on breast cancer caregiving. One of the elements that struck me most was that most caregivers for breast cancer patients are men unlike other conditions where caregivers are female. In other presentations, I learned about Dignity Therapy and how doctors may undermine the impact or weight of their or caregivers’ decision-making preferences on that of the patients’. Learning about the challenges of the different presenters in data collection and hearing suggestions from the audience to resolve these was a good learning experience.

There was a great presentation ‘Demystifying the NIH Process’ on getting funding, with Program Officers from NIH available to share their perspective and talk about trends in funding and important dos and don’ts. I am sure experienced and novice grant seekers like me found this excellent presentation very useful. I listened closely which was very important especially given that the handouts were printed in what seemed to be font size 4. I later followed this up with one-on-one conversations with the Program Officers to get feedback on some ideas.

Just when I thought I had attended all possible excellent presentations, I got to hear Rebecca Aslakson. I had met her earlier this year through a mutual colleague at Johns Hopkins. A recommendation letter from Rebecca enabled me to attend the retreat. Rebecca’s extremely stylish presentation on her research trajectory, peppered with humor and insight into patient care challenges and triumphs, led us smoothly from one topic to another. It captured the history of palliative care in the Intensive Care Units, among surgeons and referenced books on palliative care and the surgery culture. Rebecca shared that there are different moral economies and different bottom lines in medicine. Death is the enemy in surgical cultures. In contrast, for Intensive Care Unit nurses, suffering is the worst enemy. The “covenant” between patient and doctor is part of a surgeon’s identity.

Palliative care-related experiences of surgical Intensive Care Unit patients and families led Rebecca to research into peri-operative care and involving patients via PCORI mechanisms. Since people lose decision making capacity for at least some time, the research team proposed advance care planning (ACP) and did a scan of ACP instruments. This led to research on content and instrument-based approaches, studying ACP conversations, preparing story boards and eliciting public feedback through venues such as a stall at the Maryland State Fair. Many patient-doctor conversations about ACP are couched in terms of faith, which led her to start the UNITED project with churches for using religious language and input into ACP conversations.

Finally, I attended a Mock Study Section which mimicked how actual reviews are done. Excellent examples of sample grants were provided and there was a rich discussion about the grants’ strengths and weaknesses.

I had arrived at the retreat bleary-eyed and left wide-eyed, excited at the vast range of possibilities in research that can improve quality of life for patients and caregivers. The well-rounded experience covered everything from research ideas to how to fund them and provided invaluable networking opportunities. The retreat made me inspired and enthused with the dedication and brilliance of the presenters and I got new ideas on how I could contribute to patient-centered palliative and end-of-life care.

Nidhi Khosla, PhD, MPH was chosen as one of six AAHPM Research Scholars this year and received funding to participate in the Annual Kathleen M. Foley Palliative Care Retreat and Research Symposium of the National Palliative Care Research Center (NPCRC). She is an Assistant Professor at the Department of Health Sciences, University of Missouri, Columbia. Her research involves palliative and end of life care preferences of the growing number of South Asians (persons with origins from India, Pakistan, Bangladesh, Nepal, Sri Lanka, Bhutan and Maldives) in the U.S.

Highlights of the December 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

The Business Case for Palliative Care: Translating Research Into Program Development in the U.S.
J. Brian Cassel, Kathleen M. Kerr, Noah S. Kalman, and Thomas J. Smith

Original Articles

Complex Decongestive Lymphatic Therapy with or without Vodder II Manual Lymph Drainage in More Severe Chronic Postmastectomy Upper Limb Lymphedema: A Randomized Non-Inferiority Prospective Study
Tomasz Gradalski, Katarzyna Ochalek, and Joanna Kurpiewska

Interdisciplinary Palliative Care for Patients with Lung Cancer
Betty Ferrell, Virginia Sun, Arti Hurria, Mihaela Cristea, Dan J. Raz, Jae Y. Kim, Karen Reckamp, Anna Cathy Williams, Tami Borneman, Gwen Uman, and Marianna Koczywas

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

Coming to the Windy City?

The AAHPM & HPNA Annual Assembly is 100 days away! Since the Assembly is being held in the Academy’s backyard we’ve come up with 100 suggestions of places to eat and things to do while in Chicago. See what AAHPM members are looking forward to in Chicago.

Watch Twitter and Facebook for the daily #100inChicago feature. Missed a day or two? Don’t worry, we will be adding each location to the list here (in no particular order).

1. Museum of Science and Industry
2. Café BaBaReeba
3. Gibsons Steakhouse
4. Pequod’s Pizza
5. The Second City
6. Chicago Architecture Foundation Tours
7. Chicago Chapel in the Sky Tour
8. Chicago Botanic Garden
9. Chicago History Museum
10. Wrigley Field
11. Geja’s Café
12. Holy Name Cathedral Tour
13. Broadway in Chicago – Historic Theatre Tours
14. Palmer House Hilton’s “History is Hott” Tour
15. Maggie Daley Park
16. Adler Planetarium
17. Shedd Aquarium
18. Skydeck Chicago
19. 360 CHICAGO
20. Museum of Contemporary Art Chicago
21. Art Institute of Chicago
22. Bella Bacinos
23. Garrett Popcorn
24. Mr. Beef and Pizza
25. Mr. D’s Shish-Kabobs
26. Central Gyro
27. Goose Island Brewery Tour
28. Gene and Georgetti
29. The Rosebud
30. Bulls Game
31. Lakefront Segway Tour
32. Brunch at The Signature Room at the 95th
33. Walking Tour of Chicago
34. Chicago Theatre
35. Publican
36. Judy Istock Butterfly Haven at the Peggy Notebaert Nature Museum
37. Chicago Shakespeare Theater on Navy Pier
38. Scooter’s Frozen Custard
39. DuSable Museum of African American History
40. Music Box Theatre
41. Chicago Cultural Center
42. Chicago Riverwalk
43. The Magnificent Mile
44. National Museum of Mexican Art
45. J. Parker
46. Myopic Books
47. Kingston Mines
48. Cadillac Palace Theatre
49. Goodman Theatre
50. Annoyance Theatre & Bar
51. Lookingglass Theatre Company
52. Blue Man Group
53. Chicago Symphony Orchestra
54. Victory Gardens Theater
55. Field Museum
56. Lyric Opera of Chicago
57. Driehaus Museum
58. Apollo Studio Theater
59. The Den Theatre
60. Logan Square Studio
61. Smart Museum of Art
62. Uptown Underground
63. ComedySportz Theatre
64. Chicago Flower & Garden Show Navy Pier
65. Gene & Jude’s
66. Northlight Theatre
67. 2nd Fridays on the Chicago Cultural Mile
68. Acadia
69. Borinquen Lounge
70. Ann Sather
71. Evolve Bistro at Art Institute
72. Honky Tonk BBQ
73. Old Fashioned Doughnuts
74. Palace Grill
75. Buddy Guy’s Legends
76. McCormick & Schmick’s Seafood & Steaks
77. Lou Malnati’s Pizzeria
78. Mercat a la Planxa
79. Museum of Contemporary Photography
80. Lincoln Park Zoo
81. Cemitas Puebla
82. Cookie Bar – Gluten Free Bakery
83. Girl & the Goat
84. Mindy’s Hot Chocolate
85. Taste of Peru
86. The Purple Pig
87. Kumas
88. 90 Miles Cuban Cafe
89. Carnivale
90. Sheffield
91. Las Tablas
92. Green Mill
93. Revolution Brewing
94. La Pasadita
95. White Palace Grill
96. Tre Kronor
97. Smoke Daddy
98. Molly’s Cupcakes
99. Irazu
100. Luxbar

There are many more than 100 things to do and places to eat while in Chicago for the Annual Assembly. Below you will find more suggestions for you while on your trip.

Experience the St. Patrick’s Parade and river dyeing Saturday, March 12. Purchase green Hospice Hero and Palliative Power socks at the AAHPM Resource Center.
16th Street Theater
A Red Orchid Theatre
American Theater Company
Avanti Caffé
Take a Carriage Ride on Michigan Avenue
Chicago Chop House
Chicago Cut Steakhouse
Chicago Pizza and Oven Grinder Co.
Chilam Balam
Chuck’s Southern Comforts Cafe
Clarence F. Buckingham Memorial Fountain
Corn Productions at Cornservatory
DMK Burger Bar
Eataly
Fogo de Chao Chicago – Bring your Assembly badge to receive 15% off bill March 8th – March 12th.
Garfield Park Conservatory
Gino’s East
Giordano’s
Gorilla Tango
Grant Park
Laugh Factory Chicago
Lawry’s
Lifeline Theatre
Madison Street Theatre
Maggiano’s Little Italy
Michael Jordan’s Steakhouse
Millennium Park
Morton’s
Navy Pier
Nottoli
Pastoral
Philly’s Best
Ponce
Raven Theatre
Rockit Burger Bar
Smith & Wollensky
Smoque BBQ
Stage 773
Steppenwolf Theatre Company
Las Tablas
The Mercury Theater Chicago
The Violet Hour
Theo Ubique Cabaret Theatre
Trap Door Theatre
Tuscany

Visit AnnualAssembly.org for more information and to register!

New FAAHPM – Rebecca A. Aslakson, MD PhD FAAHPM

Congratulations to Dr. Rebecca Aslakson who recently earned the designation Fellow of the American Academy of Hospice and Palliative Medicine. This new Fellow of the Academy was asked – what would you say is the biggest opportunity for the field of Hospice and Palliative Medicine? We are sharing her answer in this post.

“For me, the biggest opportunity in HPM is identifying, studying, and implementing natural moments in daily life and routine medical care to proactively incorporate palliative care and advance care planning. Many providers consider palliative care approaches only when a patient reaches late stage disease – a cancer patient has already progressed through three rounds of chemotherapy or the ALS patient is now possibly needing ventilatory support. The opportunity is to move “upstream” and to find new moments and ways to integrate HPM, particularly by primary palliative care providers. How can a primary care physician incorporate elements of advance care planning with any new diagnosis of prostate cancer? How might a surgical team include advance care planning into the medical workup prior to a colectomy? What simple things can ICU teams do to improve patient symptom experience? And, for whatever reason, if primary teams are unable to take these opportunities to improve patient care, then how can we build a system so that these issues are instead addressed by specialist palliative care providers? We need data to support that these “upstream” approaches improve meaningful patient, family, and healthcare system outcomes and then we need ways to disseminate both the data and the practices. These are immense opportunities to improve medical care experience by all patients and their loved ones!”

Advancement to fellowship status within the academy honors dedication to and scholarship in the field of the hospice and palliative medicine. This distinction represents a minimum of 5 years of membership, participation in AAHPM activities, letters of recommendation, and board certification in hospice and palliative medicine. Dr. Aslakson will receive the designation during the Annual Assembly of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association in Chicago, IL on Saturday, March 12, 2016.
Check back regularly for posts from other Fellows.

Medicare Pay for Advance Care Planning Doesn’t Fall That Short

By Phil Rodgers, MD FAAHPM
AAHPM Public Policy Committee Co-chair and RUC Advisor

Dr. Jennifer Brokaw’s article from Time magazine linked in the 11/10 SmartBrief concludes that CMS payment for advance care planning (ACP) services, that will start January 1, 2016, is inadequate to support the time necessary for physicians and qualified providers to provide advance care planning services. The article reaches this conclusion by citing that reimbursement amounts are limited to ‘initial’ palliative care consultation and ‘follow-up’ consultations, and thus do not allow payment for longer, more involved ACP and goals of care discussions.

Dr. Brokaw’s attention to the topic is very welcome, but her article may leave readers confused as to the use and value of the new CPT codes for advance care planning. Specifically, the new Current Procedural Terminology (CPT) codes would allow payment for ACP services of any length, including the long, complex discussions that are a practice staple of hospice and palliative care providers. 99497 (~$86) can be billed for the first 30 minutes of ACP services on a given day, and 99498 (~$75) can be billed for each additional 30 minutes of service performed on the same day, with no limit. There are no frequency limitations to these codes, so they may be used as often as the need arises.

They may be also be used in addition to most other inpatient and outpatient evaluation and management (E/M) codes, provided that the time counted to bill the ACP codes is only counted for ACP services, and not also used to meet time-based criteria for an E/M code. There are a few E/M codes (like those for some critical care services) alongside which the new ACP codes cannot be billed—so do read the fine print, preferably with your practice’s billing professional or consultant.

It is important to note that while CMS issued no specific documentation requirements for use of the new ACP CPT codes, they will be subject to audit. In fact, Medicare contractors may be watching a little more closely given that these codes are new, and there is an interest in making sure they are billed only when the services are delivered. As always, make sure you are documenting (in detail) the services that you perform.

I do agree with Dr. Brokaw that the new Advance Care Planning CPT codes are not a solution to better payment for advance care planning and palliative care services. They are, however, an important step in the right direction. In fact, AAHPM worked with other medical specialty societies to advance the new CPT codes for advance care planning, including presenting data from member surveys to the American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) which suggested relative values for the codes to CMS.

For more information, please review the CMS fact sheet and full text of 2016 Medicare Physician Fee Schedule Final Rule.”

New FAAHPM – Kevin A. Ache, DO FAAHPM

Congratulations to Dr. Kevin Ache who recently earned the designation Fellow of the American Academy of Hospice and Palliative Medicine. This new Fellow of the Academy was asked – what brought you to the field of Hospice and Palliative Medicine? We are sharing his answer in this post.

“One morning on inpatient rounds, I walked into an elderly patient’s room in the beginning of my second year as a Family Medicine Resident. Her story was one that we as physicians hear much too often. She came into the Emergency Room with shortness of breath exacerbated by her congestive heart failure. It was her fourth admission in as many months.

I feel that as physicians we are trained to “fix the problem” at any cost. We continue to treat aggressively despite asking what the patient wants. We lose sight of the overall picture including the most important aspect, quality of life. Of course, this is different for everyone and I feel that it is our duty to explain to all of our patients and their families the different options they have in regards to their medical treatment. We need to present their disease process in a way they can understand, not just telling them that “their numbers are looking better/worse”. I want everyone to understand that they have the ultimate choice in how we treat their illness. Whatever decision they make I will respect, but I feel that as a profession we have lost sight of this and it is my job to help them maneuver down this journey we call life. This is what brought me into the field of Hospice and Palliative Medicine.”

Advancement to fellowship status within the academy honors dedication to and scholarship in the field of the hospice and palliative medicine. This distinction represents a minimum of 5 years of membership, participation in AAHPM activities, letters of recommendation, and board certification in hospice and palliative medicine. Dr. Ache will receive the designation during the Annual Assembly of the American Academy of Hospice and Palliative Medicine and the Hospice and Palliative Nurses Association in Chicago, IL on Saturday, March 12, 2016.

Check back regularly for posts from other Fellows.

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

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

Fentanyl Buccal Tablet vs. Oral Morphine in Doses Proportional to the Basal Opioid Regimen for the Management of Breakthrough Cancer Pain: A Randomized, Crossover, Comparison Study
Sebastiano Mercadante, Claudio Adile, Arturo Cuomo, Federica Aielli, Andrea Cortegiani, Alessandra Casuccio, and Giampiero Porzio

A Pilot Randomized Controlled Trial of a Holistic Needs Assessment Questionnaire in a Supportive and Palliative Care Service
Nisar Ahmed, Philippa Hughes, Michelle Winslow, Peter A. Bath, Karen Collins, and Bill Noble

Usability and Acceptability of the QDACT-PC, An Electronic Point-of Care System for Standardized Quality Monitoring in Palliative Care
Arif H. Kamal, Dio Kavalieratos, Janet Bull, Charles S. Stinson, Jonathan Nicolla, and Amy P. Abernethy

Managing Medications During Home Hospice Cancer Care: The Needs of Family Caregivers
Jennifer Tjia, Lee Ellington, Margaret F. Clayton, Celeste Lemay, and Maija Reblin

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

Notes from the Field

by Jordan Endicott, JD
Manager, Health Policy & Advocacy

I’ve worked in the health care related field for nearly the entirety of my professional career, but surprisingly, the last time I had stepped foot in a hospital was at age 10 when I broke my wrist. When I was offered the opportunity to visit Drs. Christian Sinclair and Paul Tatum at their respective hospitals, I was excited for the chance to reacquaint myself with a system that I was really only familiar with in an abstract way.

We spent the first day of our trip with Dr. Sinclair at the University of Kansas Medical Center, spending time with the interdisciplinary team there, and then seeing patients with Dr. Sinclair and a nurse from his team. The patients we saw ranged from those nearing the end of life, to cancer survivors who were left with pain and complications following treatment. The one constant though from all of the visits was that Dr. Sinclair and the nurse kept the focus on what the patient wanted and desired.

After a day spent in Kansas City, we made the short trip over to Columbia, Missouri where Dr. Tatum works at the University of Missouri. Dr. Tatum took us on a whirlwind tour that involved seeing a patient in the hospital, shadowing him during his primary care clinic hours, and ending the work day in Jefferson City to meet with Jane Moore, the CEO of the Missouri Hospice and Palliative Care Association.

When I first informed my friends and family earlier this year that I was accepting a job with the American Academy of Hospice and Palliative Medicine, the most common reaction was along the lines of “wow, that sounds terribly depressing” or “why would you want to do that to yourself?” The reaction was much the same when I told everyone that I’d actually be visiting two of our members and seeing their patients.

My usual response to the negative thoughts that people have to the field of end-of-life care is that our members are working every single day to enhance aspects of patient care that are in need of vast improvement. After seeing firsthand the relief and care that our members provide though, the biggest take away for me is that hospice and palliative care is absolutely not depressing – it’s the fact that thousands of patients across the country still lack awareness or access to this care that is a cause for sorrow. I was already proud of the work I do in supporting our members, but after my visit, I’m even more grateful for the opportunity to work for the Academy and advocate for the field of hospice and palliative medicine.

A Day in the Life…

by Jen Bose, Marketing & Membership Manager

Working with AAHPM for several years has allowed me to get to know some of our members fairly well. I look forward to the Annual Assembly and summer courses each year because I get to connect with members in real life. When the opportunity for Jordan Endicott, Manager of Health Policy and Advocacy, and I to visit Drs. Christian Sinclair and Paul Tatum came up I jumped at the opportunity. Not only would I get to see what they do on a “typical” day I would also be able to understand how the Academy impacts everyone working on the interdisciplinary team and the patients and their families.

Thursday September 24
Kansas University Hospital – Kansas City, KS

We started the morning watching offsite lectures with fellows with Dr. Sinclair. After the lectures we met the three palliative care teams as they discussed the patients for the day. Then we were off to see patients with Dr. Sinclair and the nurse on his team. Each patient had a unique situation and required a slightly different approach and discussion. Some of the discussions were led by Dr. Sinclair and some were managed by the nurse. Every conversation focused around the patient. For some it was about how he or she was feeling that day and what could be done to make him or her more comfortable. For others it was finding out what their expectations were in their recovery and what their quality of life goals were. All of the conversations were warm and personable with a focus on making sure everyone was on the same page. We ended the day at the National World War I Museum before eating delicious barbeque.

Friday September 25
University of Missouri – Columbia, MO

The day started with a team meeting and shadowing a patient visit at the University. We then made our way over to the office where Dr. Tatum sees his geriatric patients. All of the patients adore Dr. Tatum and based on the appointments it is easy to see why. He knows them all very well and has very supportive conversations with them about their present situation and what they hope for in the future and suggestions on how they can get there. We were able to meet the nurse that Dr. Tatum works with in the office that serves as his right hand woman. Then we were off to Jefferson City to meet with the CEO of a state level hospice and palliative care organization. She explained some of the issues that she has been facing in the state and the amazing educational offerings that her organization has created. Our night ended at the Roots N Blues N BBQ Festival where we met up with Dr. Gregg VandeKieft to enjoy music and great food.

Final Thoughts

I was confident that I knew what our members did but in an abstract way. I have seen the process firsthand when my Grandma started a palliative care treatment plan and eventually hospice. Shadowing Dr. Sinclair and his team at the hospital and Dr. Tatum at the hospital and clinic was truly eye opening. The warmth and compassion that was present in every conversation was astonishing. I often found myself on the verge of tears and so proud to work with the amazing people working in hospice and palliative medicine every day.

Back to the Old Schoolhouse − Students of Different Professions Learn Palliative Care Together

By Joseph D. Rotella

More and more academic centers are developing interprofessional education (IPE) programs to teach palliative care− and it makes good sense. Seriously ill patients and their families suffer as whole human beings and it takes a village of palliative care providers from different disciplines working together to comfort, support, and heal them. If we train palliative care professionals in silos, how can we expect them to be prepared for effective interdisciplinary teamwork when they emerge?

The feature story in the American Academy of Hospice and Palliative Medicine (AAHPM) Fall Quarterly (2015), Interprofessional Education: The More, the Healthier, highlights some of the programs across the country that are doing groundbreaking work in IPE.

It may be easy to see the promise of interprofessional training in palliative care, but it’s hard to do it well. In an AAHPM blog post accompanying the article, Dr. V.J. Periyakoil describes her personal experience as faculty for the VA Interprofessional Fellowship Program, “A gold standard is when all IPE fellows are taught at a level that is challenging to all of them in every single session.” That sets a high bar and she adds, “This area is really ripe for discovery and new innovation.” Like the pioneer teacher with K through 12 students in one classroom, IPE instructors strive for a curriculum that can engage learners with a wide range of individual competencies. When it works well, the students learn as much from each other as they do from their teachers.

When I think back on my own development as an internist and palliative care physician, I am struck by how much I learned informally from my colleagues in other professions. When I was a green intern on my first Cardiac Care Unit (CCU) rotation, it was an experienced (and extremely patient) CCU nurse who showed me how to run a code. Counselors taught me how to deal with challenging families and support the grieving. From chaplains, I learned to understand people in the context of the meaning of their life stories. Social workers modeled how to empower patients and families and to have healthy boundaries. A pharmacist shared best practices on stopping unnecessary medications. A nurse’s aide showed me how a bed bath can be a sacred ritual. I had some great physician mentors, but I think I learned more about palliative care from the interdisciplinary team than from other doctors.

My first experience with formal IPE was about a decade ago when I was a facilitator for a discussion group of medical, nursing, social work and pastoral care students following a screening of the film Wit. One medical student resented the whole process. He said, “This is absurd; no real doctor would behave as badly as the ones in this film.” The other medical students nodded their agreement. A nursing student rolled her eyes and said, barely audibly, “Actually, that is exactly what they do.” Her peers agreed. This was a fantastic teachable moment. IPE is not just about developing knowledge and skills. It’s also about opening minds and removing cultural barriers to teamwork.

Dr. Joe Rotella, MD MBA HMDC FAAHPM is the Chief Medical Officer, AAHPM and a frequent participant in #hpm (hospice and palliative med/care) chat.

What: #hpm chat on Twitter
When: Wed 10/14/2015 – 9p ET/ 6p PT
Host: AAHPM and Steve Smith, CEO of AAHPM

Some questions to ponder for the chat:
1. Are there opportunities for interprofessional palliative care training in your program? If so, how do they work?
2. What do you find to be the biggest challenges to interprofessional learning and collaboration?
3. What is the greatest lesson you ever learned from someone outside your profession?

If you are new to Tweetchats, you do not need a Twitter account to follow along. Try using the search function on Twitter. If you do have a Twitter account, we recommend using tweetchat.com, for ease of following.

You can access the transcripts and analytics of #hpm chats through @Symplur.