Hospice and Palliative Medicine

Palliative Care and Hospice Organizations Collaborate to Advance the Field

The National Coalition for Hospice and Palliative Care: Working together to coordinate, communicate, and collaborate on advocacy, quality, and beyond

Inaugural Issue #1 – What is the Coalition? Why is it Important?

Welcome to the first blog post from our Coalition. If you have attended a hospice or palliative care conference in the last few years, it is likely that you have heard the proverb, “If you want to go fast, go alone. If you want to go farther, go together.” The National Coalition for Hospice and Palliative Care (also referred to as the Coalition) is a critical mechanism for ensuring that the field goes far. Originally established by four organizations in 2002 to create a foundation for defining quality palliative care, i.e., National Consensus Project, Clinical Practice Guidelines for Quality Palliative Care, the Coalition is now comprised of nine national organizations representing clinicians from the full interdisciplinary team (physicians, nurses, social workers, chaplains, and physician assistants), researchers, and hospice and palliative care programs. The Coalition’s goals focus on four essential elements, the “Four C’s”: Cooperation, Communication, Coordination, and Collaboration.

Coalition Members


These nine hospice and palliative care organizations work independently to improve quality of life for seriously ill patients by addressing the needs of their constituencies in areas such as education, advocacy, quality improvement, research, etc. While each has been incredibly effective on its own, the field as a whole faces many challenges:

  • Rapid evolution of health care and health policy in the U.S.;
  • Rapid increase in the number of people who would benefit from palliative care and/or hospice services;
  • Rapid proliferation of new interventions/initiatives designed to address the high-need, high-cost populations (some with the patient and family in mind, some with cost savings in mind), creating much “noise” around the right way to care for these patients;
  • Continued misconceptions about what hospice and palliative care can offer and who is eligible for these services; and
  • Limited resources in our small field.

Using the Four C’s, the Coalition helps the field proactively address these challenges by convening representatives monthly from each organization to strategize on key public policy challenges; improve communication to avoid duplication of effort where possible; and share intellectual resources. We work together to respond to legislative and regulatory opportunities, and are structured to nimbly respond to significant opportunities and threats (e.g., the recent misrepresentation of palliative care by a U.S. Senator). But the most important function of the Coalition is to initiate and strengthen relationships across the field. As a result of the Coalition, members often feel more comfortable reaching out to each other individually as needed to clarify an issue, brainstorm ideas, and collaborate on new initiatives. By finding natural opportunities to work together, we strengthen each other and increase our impact – both within the field and to external audiences.

Our next post will describe the Coalition’s structure and its core activities and accomplishments. In the meantime, check out the Coalition’s new website where you can find more information about the work of our Coalition.

Amy Melnick, Executive Director, National Coalition for Hospice and Palliative Care

Stacie Sinclair, Center to Advance Palliative Care (CAPC) & Coalition Member

Participate in Mapping Community Palliative Care

The Center to Advance Palliative Care (CAPC), in collaboration with the National Coalition for Hospice and Palliative Care (NCHPC), is launching an exciting new initiative to build a comprehensive inventory of community palliative care programs across all service settings—including home, office/clinic, and long-term care.

While there is growing research demonstrating the positive impact of palliative care in these settings, there are no reliable data on (non-hospice) palliative care capacity outside of hospitals. Mapping Community Palliative Care will develop estimates of palliative care access in communities across the country and track growth over time. AAHPM is supporting this important project because it will promote the expansion of community palliative care by identifying models of service delivery and providing summary and comparative data for the field. And it will make it easier for patients, families, caregivers, and practitioners to find palliative care services in their community.

How can you help?

  • In order for this project to succeed, we need all community-based programs to participate. Complete a brief survey on the Mapping Community Palliative Care website to put your program on the map. Participation takes less than ten minutes.
  • Spread the word about the project by sharing this email with other community palliative care programs.
  • Follow AAHPM and @CAPCpalliative on Twitter and share posts about the project.

Participating programs will be highlighted in the Provider Directory at GetPalliativeCare.org, an online resource for palliative care information for people with serious illness and their families.

Visit the Mapping Community Palliative Care website to learn more and participate.

Meet Our 5,000th Member!

It is with great excitement that we share that AAHPM membership has exceeded 5,000 members! This is the largest our membership has ever been and we couldn’t be where we are today without each member’s hard work and dedication to the field. To celebrate this milestone, we reached out to our 5,000th member, Kelsey Terland, MD.

Dr. Terland is currently a hospice and palliative medicine fellow at Providence Alaska Medical Center in Anchorage, AK. She isn’t native to Alaska though. She was raised in Oregon, but moved to Alaska after college. Dr. Terland attended the University of Washington School of Medicine WWAMI program which allowed her to stay in Alaska for most of her medical training. She then completed her residency at the Family Medicine Residency of Idaho in Boise.

When we asked Dr. Terland how she became interested in hospice and palliative medicine, she shared her story.

“Looking back I feel like I knew my heart was in hospice and palliative medicine even before I went to medical school”, said Terland. “Prior to medical school I worked as a case manager for patients with Alzheimer’s and related dementias. I volunteered for my local hospital’s No One Dies Alone program where I would sit with patients who were at the end of their life if they did not have family or friends to be with them. Throughout my medical training I maintained my interest in the field by participating in preceptorships with providers in the field. During my family medicine residency, I continued to find myself drawn to working with patients facing serious illness and those at the end of their lives. I spent a month during my residency working with the HPM fellowship in Anchorage and this solidified my desire to commit to the field by entering fellowship. I’m so excited for what the future may hold!”

Being a hospice and palliative medicine fellow in Alaska can be a challenge, as the state is “geographically enormous with an incredibly diverse population”, Terland says. “There are inspiring people here thinking very creatively about how to reach patients across our vast state to bring hospice and palliative medicine into very rural villages”.

Terland joined AAHPM as a way to connect with other professionals in the field and gain access to educational materials, as well as to stay up to date with the latest research.

When she isn’t dedicating her days to hospice and palliative medicine, Terland is spending time with her supportive husband and two energetic little boys, exploring the beautiful wilds of Alaska.

Kelsey Terland, MD with her two little boys

The Faculty’s Top 5 Reasons to Attend the AAHPM Board Review Course

The Summer Institute will be featuring an Intensive Board Review Course on July 25-27 in Pittsburgh, PA. Get ready for your Hospice and Palliative Medicine board certification examination by experiencing this redesigned program which includes didactic presentations, interactive sessions and exam-style questions.

1)      You’re awesome.  Let’s face it, other fields may have some nice folks, but I’ve never meet a community like AAHPM.  Where else are you going to meet hundreds of bright, articulate, and compassionate people with well-honed listening skills?  Find friends and colleagues that you’ll enjoy seeing throughout your career.  It’s time to meet your tribe, and your tribe is exceptional.

2)      “This is only a test.”  Beyond a few hours of clicking answers, possessing deep understanding of your field and of the human experience will offer personal and professional benefits throughout your life.  Prepare for the REAL test – the test at the bedside. Mastery of hospice and palliative medicine comes with interacting with the material and challenging yourself and your colleagues.  Start your career strong!

3)      It’s not for everyone.  You know that lucky person who got to see the stadium-packing rock band in an intimate venue 20 years ago?  This is your one-time chance to spend a full day in an intimate setting, having direct interaction with palliative care experts.  While the larger annual assembly offers packed conference rooms and lots of excitement, this is something far different: an opportunity to be up close and personal.

4)      Improve your chances.  There are many joys of practicing in hospice and palliative medicine.  Sitting in a testing room is not one of them.  Do this well and do this once!

5)      Pittsburgh.  Yes, really.  This a great American city that is too-often overlooked.  Enjoy the panoramic views from the Dusquene Incline.  Join us for a Pirates game, visit the Andy Warhol Museum, or enjoy the waterfront trail loop at Three Rivers Park.  Beauty and wonder are there to be found if you only take the time to look.

The early bird rate ends Tuesday, June 28. Register now and save!

A Take on the Hospice Course – From the Presenters

The Summer Institute is featuring Hospice Practice is Changing – Take Charge! where you can learn the latest knowledge and tools to advance your practice and prepare for what’s coming. See what the presenters have to say about this upcoming course in Pittsburgh, PA, July 26-27, 2016.

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Deepen your knowledge and understanding of the Medicare hospice benefit to ensure your hospice is providing and documenting care that aligns with regulatory compliance.  This course will include a review of the basics, plus discuss regulatory changes and challenges – including relatedness, eligibility, narrative construct, and the new payment model – a worthwhile investment for all hospice medical directors, novice or seasoned!

- Ruth Thomson, DO FACOI FAAHPM HMDC, Chief Medical Officer at Hospice of Dayton, Inc.
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Learn how healthcare reform is likely to impact the hospice industry as we move to a value based reimbursement system. Identify benchmarks to monitor for your hospice organization to keep you in compliance and away from the auditors!

- Janet Bull, MD, Chief Medical Officer at Four Seasons

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Learn how to “debride” those insanely long lists of medications and make solid, evidence-based decisions about which ones are worth keeping and which medications can be “voted off the island.” We will introduce you to a 5 step process of deprescribing and discuss common classes of medications that leave us scratching our head: statins, PPI’s, anticoagulation, and medications used for dementia, COPD and diabetes. Everyone wins when the medications are directed the most benefit and least risk!

- Kathryn Walker, PharmD BCPS CPE, Senior Clinical Director of Palliative Care at MedStar Health
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Haven’t taken a day for yourself in months—or years?! Come rejuvenate, rewind, relax and revisit the core of what brought you into caring for dying patients and their families. Discover the latest research on burnout and the innovative approaches recently developed to promote resiliency in those of us working in overburdened hospice and palliative care teams. Network with physician colleagues and engage in topics from leadership opportunities to regulatory compliance. Let your mind and spirit be nurtured for a few days this summer – you’ll leave feeling confident and focused on how to grow and prosper in your role in hospice care.

- Kathleen Faulkner, MD FAAHPM, Good Shepherd Community Care

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A whirlwind tour of pain management topics ranging from bread and butter issues to more difficult situations and a few cutting edge techniques as well.

- Bruce Scott, MD FACP, HMDC, Assistance Professor of Internal Medicine, Wright State Physicians
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Learn more at www.aahpm.org/summerinstitute. Register soon. The early bird rate ends June 28.

First Neuro-Palliative Care Workshop in Peru

On May 13-14 2016, the Peruvian Societies of Palliative Care (Sociedad Peruana de Cuidados Paliativos, SPCP) and Neurology (Sociedad Peruana de Neurologia, SPN) held their first two-day conference and workshop on “Palliative Care and Neurology” in Lima, Peru. In a country without a palliative care training program, and where the development of palliative care is limited, 90 Peruvian neurologists, neurointensivists, geriatricians, palliative care specialists, nurses, as well as some patients from the Peruvian national neurological institute (Instituto Nacional de Ciencias Neurologicas, INCN) gathered to learn about palliative care principles and the ethical considerations and challenges of neurological illness and disability. Dr. Claire Creutzfeldt, Assistant Professor of Neurology at the University of Washington, was gave an overview of neuro-palliative care and run a VitalTalk communication workshop, providing a framework for approaching discussions regarding serious illnesses.

Invited political and healthcare leaders included: Pilar Mazzetti Soler, MD PhD, neurologist, former Peruvian Minister of Health and president of the SPN and INCN; Lilian Hidalgo, MD, vice president of the SPCP; Maria Chumbe MD, neurointensivist at the INCN; and Claire Creutzfeldt, MD. These leaders participated in a roundtable discussion entitled “Visions for Neuropalliative Care in Peru” – fielding questions and debating the next steps to facilitate the growth of palliative care. Specific aspirational goals emerging from the conference included: (1) incorporation of palliative care specialists into clinical neurology ward teams; (2) development of home health and hospice programs; and (3) integration of a palliative care curriculum for medical school and residency programs.

The conference was co-organized by NIH Fogarty Global Health Scholar Anastasia Vishnevetsky, MDc from the Perelman School of Medicine at the University of Pennsylvania, and Peruvian Geriatrician Carla Zapata del Mar, MD. The Peruvian Society of Neurology and the Peruvian Society of Palliative Care co-hosted the event. Additional support was provided by the NIH Fogarty Interdisciplinary Cerebrovascular Diseases Training Program in South America (ICTuS) Grant (5D43TW009137, awarded to Drs. Joseph Zunt, Hugo Garcia and David Tirschwell) and the NIH Fogarty Global Health Fellows Program (R25TW009345, awarded to Drs. Joseph Zunt, Chandy John, Joseph Kolars and Vivek Nerurkar).  Special thanks to Drs. Juan Luis Cam, Mario Cornejo-Olivas and Miriam Cuba for their help and support with the conference organization.

Retreat into Learning and Wisdom

The AAHPM Research Scholars Program facilitates participation for AAHPM members to attend the Annual Kathleen M. Foley Palliative Care Retreat and Research Symposium of the National Palliative Care Research Center (NPCRC), cosponsored by the Hospice and Palliative Nurses Association (HPNA), American Cancer Society (ACS), and AAHPM. The 2015 event was held October 20 – 22 in Jackson Hole, Wyoming. Below are some reflections from this year’s scholarship winners.

“This year’s retreat was by far the most inspiring conference I have attended thus far in my career. The location was serene and peaceful in Jackson Hole, and around every corner was a preeminent thought leader in palliative care. I was in awe of everyone’s tremendous accomplishments and passion for their work. I loved being able to bounce ideas off some of the most powerful minds in the field, and I felt honored that these individuals seemed truly interested in what I was saying. I felt that, by simple virtue of the fact that I was invited to be there, my views and ideas were important and worth listening to. It was a validating feeling. I left Wyoming with a renewed sense of energy to move my own work forward, and with many new colleagues and friends.”

Kavita V. Dharmarajan, M.D., M.Sc.
Assistant Professor of Radiation Oncology and Palliative Medicine
Department of Radiation Oncology
Brookdale Department of Geriatrics and Palliative Medicine
The Mount Sinai Medical Center
New York, NY

“I wanted to thank AAHPM again for giving me the opportunity to attend the NPCRC retreat. It was a tremendous privilege to be able to attend and indeed one of the most valuable experiences of my career so far. I was in awe and near disbelief seeing the guest list for the conference – it was a who’s who of palliative care and was practically my PhD literature review come to life! I had the opportunity to meet privately with so many including Diane Meier, Scott Halpern, Joan Teno, Tony Back, James Tulsky and reconnect with others I hadn’t had the opportunity to see in a while such as Randy Curtis, Sydney Dy, Christine Ritchie, and many others. Thank you so very much!

Elizabeth Dzeng, MD, MPH, MPhil, MS
Assistant Professor of Hospital Medicine and Social and Behavioral Science
University of California, San Francisco

“I felt honored to be amongst so many palliative care expert researchers. I was very pleased with the welcoming spirit of everyone. The setting was perfect. Although an intensive two days, it was a relaxed atmosphere and the prodigious learning environment. It was well balanced with free time to explore the environment and also have the opportunity to get to know one another. As a new investigator, I was able to have discussions to assist me with moving my research forward. Hearing successful experiences of senior investigators gave me an atlas to navigate not only the scientific field of PC research but my individual career development. It was also good to interact with other junior investigators and develop possible, future collaborative relationships.

The overall wealth of information and research experience was infinite. Everyone was open to sharing their experience and made me feel as though I have something valuable to offer the field and know that there is support in my development.”

Danetta E. Sloan, PhD, MA, MSW
IRTA Post Doctoral Fellow
National Institutes of Health
Pain and Palliative Care Service
Bethesda, MD

“In October, I got to attend one of the most remarkable retreats in palliative care as an AAHPM Research Scholar: The Foley Retreat. Surrounded by the beauty and mountain air of Jackson Hole, the retreat fostered an unbelievable degree of connectivity so that more junior investigators, like me, were able to connect with a variety of individuals to learn from, develop collaborations that previously didn’t exist, and be part of conversations that felt like a form of improvisation. It was incredible. Thanks to everyone at AAHPM for supporting the research scholars program! I am very grateful to be a part of it.”

Carey Candrian, PhD
Assistant Professor | University of Colorado School of Medicine | Division of General Internal Medicine
Protocol Specialist | Palliative Care Research Cooperative Group (PCRC)

“Thank you so much for the opportunity of coming to the Palliative Care Research Retreat and Symposium—it was amazing! It was inspiring to be amongst the thought leaders in the field, and to see the innovative research that is driving the field forward. I look forward to being able to contribute. =)”

Jessica R. Bauman, MD
Assistant Professor, Department of Hematology/Oncology
Fox Chase Cancer Center
Philadelphia, PA

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.

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.”

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.