Annual Assembly

A One-On-One with Extremis’ Dr. Jessica Zitter

In September 2016, Netflix released an original documentary, “Extremis”; a 24-minute account of the end of life experience in an ICU setting. The AAHPM member featured in the documentary, Jessica Zitter, MD, recounts her journey to becoming a hospice and palliative medicine physician and her idea for the documentary.

“In 2009, I realized the need for a movie addressing the state of dying in the Intensive Care Unit.  I had just seen “The Waiting Room,” a documentary which depicted the humanity and suffering of patients in the ER of Highland Hospital, the county hospital for Oakland, California.  I had just started working there a few months earlier.  I was blown away by the film’s rich visuals and gripping stories.  I wanted to bring that same lens to the issue of medical decision-making in the Intensive Care Unit. In this high-stakes environment, dying patients are often put on what I call the “End of life Conveyor Belt:” lined up for default high-technology life-prolongation, often without their consent or understanding.

It was a topic I couldn’t stop thinking about — although it hadn’t started out that way.  When I was a young attending in the ICU at University Hospital in Newark New Jersey, I was all about life-prolongation, always seeking that high-technology heroic rescue.  But an awareness was dawning that something wasn’t quite right.  I just didn’t know exactly what.  Then in 2003 the burgeoning Palliative Care movement found me, and rescued me from my growing moral distress.  By a stroke of luck, I happened to work at the University of Medicine and Dentistry of New Jersey (now called New Jersey Medical School), one of only four institutions to receive a grant from the Robert Wood Johnson Foundation to improve communication in ICUs.  These grants were part of RWJ’s larger initiative called Promoting Excellence in End of Life Care, run by our own Dr. Ira Byock. They were awarded in March 2003, and I was hired at UMDNJ in May of the same year.

I knew nothing about this grant until I was introduced to the members of the “family support team,” the precursor to what would become the Palliative Care team years later.  I saw them roaming the rooms of our ICU, clipboards in hand, asking patients questions I would never have thought to ask: did they understand what was going on, what was important to them, were they in pain?  Although I was initially resistant to the team’s remonstrations – “Why are you putting that catheter into a dying patient without telling her family she is dying?”- I quickly realized they were raising critical issues. Before I knew it, I was a convert. Under the guidance of Pat, the advance practice nurse who led the team, I began to practice more patient-centered care, and later passed my Palliative Care boards.  Over the ensuing years, I’ve become convinced that the Palliative Care toolbox is absolutely crucial to patient-centered practice in the ICU.

After seeing “The Waiting Room” I approached the director, Peter Nicks, and asked him if he would be willing to put a face on the suffering of patients in the ICU.  There were so many patients receiving non-beneficial and even harmful treatment, I told him. Pete, busy on another project, introduced me to Dan Krauss, who went on to direct “Extremis.” Dan, although an outsider to medical culture, was able to bring incredible sensitivity and insight to this very complex world.


I’m thrilled, and a little astonished, at the response to the film.  The initial Netflix trailer went viral, garnering an unprecedented 5.5 million views in the first three days. I believe that this indicates the potential for change in both the lay and medical communities. I am in the process of creating a teaching curriculum for medical professionals and trainees which will focus on some problematic areas within our current medical culture, particularly in the ICU, and begin to explore structural solutions for change. I hope soon to be able to provide this curriculum to the many medical schools and communities contacting me with interest in using the film in a teaching capacity.

I’ve been spending the last year working hard on a book about these issues, Extreme Measures.  The book will be published by Penguin-Random House on February 21, the day before the AAHPM conference in Phoenix.  My hope is that both the book and the movie will serve to support this movement and help show us all the need for change in the way we approach death and dying—both the lay public and the medical professionals who, like me, may have been blinded by their training.”

AAHPM will hold a book signing with Dr. Jessica Zitter at the Annual Assembly on Thursday, February 23 at 5:30pm in the Exhibit Hall. Copies of her book “Extreme Measures; Finding a Better Path to the End of Life” will be sold at the AAHPM Resource Center at Assembly.

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!

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!

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.

Philly in February? You bet!

Will you be attending the AAHPM & HPNA Annual Assembly next month? Are you wondering what there is to do in Philadelphia? Lucky for you even in February there is no shortage of great food or things to do!

Philadelphia is set apart from other cities by the variety of things to see and do around the Convention Center! Historic, family–oriented or recreational – Philadelphia has something for everyone! Covering fine arts, history, science and culture, the city often hosts unique visiting exhibits that can be found at some of the most popular attractions in the region. Discover all you need to know about Philadelphia’s Arts & Attractions and create your own list of must–sees for your visit!

The New York Times recently released a list of 52 Places to Go in 2015. Philadelphia was ranked number 3! According to the NYT Philadelphia has become a hive of outdoor urban activity.

After a long day of captivating sessions why not treat yourself to one of the many great restaurants the city has to offer? Recommendations from members include:
Cuba Libre, Zahav, Vernick, Little Fish, Nomad Pizza, Vedge, MeltKraft, Starr Restaurants including: Jones, Buddakhan, The Continental, and El Vez. Garces Restaurants including: Garces Trading Company, Amada, and Village Whiskey. Amis, Little Nona’s, Pennsylvania 6, and Barbuzzo. Capogiro Gelato was named the best place to eat ice cream in the country by National Geographic. Parc, Sbraga, Alla Spina, Fette Sau, Tallulah’s Garden, Mercato, and Stateside. Walk over to the Reading Terminal Market for lunch. There are local food vendors, Amish crafts and candy. Visit the Italian market. Craving a cheesesteak? Looking for a knock out burger? Check out other restaurants in Market East.

Where to get a drink:
Tria
Franklin Mortgage
Hop Sing Laundromat
Stratus Lounge

Great attractions:
Attend the Philadelphia 76ers basketball game against the Washington Wizards on Friday, February 27th. Use promo code AAHPM to get discounted tickets.
Liberty Bell & Independence National Historical Park and Independence Hall
Constitution Center
Betsy Ross House
US Mint
Barnes Museum
Rodin Museum
National Museum of American Jewish History
Institute of Contemporary Art
Philadelphia Museum of Art, home to the famous stairs from Rocky. Check out these other places for Rocky fans.
Eastern State Penitentiary tour.
Walk or bike along Schuylkill River trail in Fairmount Park or hike on the Wissahickon trail.
View the top free attractions in the city and a listing of additional museums and attractions.

Family activities:
North Bowl (great for adults and kids)
Smith Playground
Please Touch Museum
The Franklin Institute
Philadelphia Zoo
Adventure Aquarium which is just across the river in Camden.
Looking for more kid friendly activities? Check out the top ten family friendly activities.

Still can’t decide? Check out the official visitor and travel site VisitPhilly.com for more ideas!

Measuring What Matters at Annual Assembly

It was an exciting Annual Assembly for the Measuring What Matters team, who presented both a preconference workshop and an concurrent session to the AAHPM/HPNA membership. Some of the supportive & challenging comments we received included:

Measures are power.
Quality measures will happen, and we need to be part of the process!
Now I appreciate the complexity of this work.
Measures should look at what is meaningful, actionable and has potential impact.
Great explanation of the Core Measures process – from the ground up – unique & much appreciated!
Measures will be a driving force for sustainability.
Just because you have measures in place doesn’t mean you have quality.
Measuring What Matters brings leverage to your program. It’s not about saving money but bringing value to patients/families served.

Our quality consultant from Hart Health Strategies, Rachel Groman, commented about MWM: “AAHPM is taking the high road by determining, on its own, what is most important to its member in terms of QI rather than letting federal mandates dictate the direction of the profession. Honestly, I don’t see that much anymore.”

I am deeply grateful for what we’ve accomplished so far, and for the passion and dedication of our co-chairs and panel members. We’ve promised a draft list of measures for AAHPM and HPNA membership to comment on within two months, then we’ll be seeking further input from organizations, patients, families, and the general public.

Katherine Ast

Why I am Helping to Shape the Future

It’s hard to believe that the 2014 AAHPM & HPNA Annual Assembly is over. There is so much preparation that goes into it all year that it’s a bit surreal to be done. In a few days we will start collecting abstracts for Philadelphia and the whole process will start over!

My favorite part of the Assembly (aside from connecting with our amazing attendees) is working with the Developing Countries Scholars. I had the privilege of being the staff liaison to the 2014 Scholars: Edwina Addo, Marcos Borges, Lilian Hidalgo, Farzana Khan, Giorgi Metivishvili, Jean-Luc Nkurikiyimfura, Thai Phan, Srinagesh Simha and Charu Singh. After spending several months corresponding with them I could barely wait to meet them all in person. They are remarkable individuals that I was blessed to meet. The warmth, compassion, and dedication that they all exuded was overwhelming.

Managing the Developing Countries Scholarship program has opened my eyes to the incredible hardships that physicians are facing while trying to provide hospice and palliative care to their communities. The Scholarship Fund was created to provide access to high quality hospice and palliative medicine education to physicians living and practicing in developing countries. The scholarship recipients are able to make meaningful connections and incorporate new knowledge in their practice. The Scholarship Fund is made possible by donations to the Shaping the Future campaign. If you have donated to Shaping the Future- Thank you! If you haven’t donated- there is still time.

Jen Bose
Marketing & Membership Manager

Food & Fun in San Diego

In just two short weeks nearly 2,500 attendees will be arriving in San Diego for the 2014 AAHPM & HPNA Annual Assembly. Everyone is looking forward to another year of top notch education sessions and some sunshine after a long winter. Below are suggestions for restaurants and hot spots that the locals love and can’t miss attractions for everyone.

Restaurants
Extraordinary Desserts in Little Italy
Café Coyote in Old Town
Casa Guadalajara in Old Town
Lotus Thai
A.R. Valentien – fine dining
Bandar Persian – try their amazing chicken shish kabob
Candelas Gourmet Mexican
Hexagone – French cuisine
Old Town Mexican Café
Blue Point Coastal Cuisine
The Fish Market & Top of the Market (upstairs)
McCormick & Schmick’s Seafood & Steaks
Ocean Beach
Phils BBQ
South Beach Bar & Grille
Oscars- go to the Newport Ave Location
Hodads- burgers
BO-beau Kitchen & Bar
Sushi Ota- need a reservation
Hane Sushi
Winstons fun bar with good music

Neighborhoods
Hillcrest- lively, great restaurants
Gaslamp Quarter- tons of restaurants and is easy walking from the convention center
Seaport Village- near downtown has shopping and restaurants along the bay

Other Attractions
Shopping- Fashion Valley and Las Americas Premium Outlets
Sea World
Legoland
San Diego Zoo
San Diego Zoo: Safari Park
DisneyLand
La Jolla Cove and La Jolla Children’s Pool
Whale watching- Hornblower Cruises and Flagship Cruises
Midway Museum and USS Midway the retired aircraft carrier is fascinating
Padres baseball at Petco Park
The New Children’s Museum
Coronado- there is a ferry that goes from the convention center to Coronado. Bicycle rental is available at the ferry landing on Coronado. There are also three nice restaurants near the ferry landing. Home to Hotel Del Coronado from Some Like it Hot. Check out Miguels across from the Hotel Del Coronado

For more information about everything that San Diego has to offer check out the San Diego Convention Center and the San Diego Tourism Authority.

If you have recommendations please leave them below.

After the Annual Assembly

The Annual Assembly is over. The boxes have returned from New Orleans and we have put all the items back on the shelves. Today, we had our “Post Con” meeting and talked about the specifics: what went right and where we can make improvements for next year’s Assembly. The staff shared some interesting facts:

• 2419 attendees from 15 different countries and every state in the union were in New Orleans.
• 509 gallons of coffee were consumed at the Convention Center.
• 51 companies exhibited in the exhibit hall and 27 companies were present at the Job Fair.
• 3486 sleeping nights were reserved for attendees.
• 439 Twitterers tweeted 6716 tweets – totaling 6.1 million impressions. There was lots to talk about!
• Attendees participated in 135 educational sessions and purchased 286 of recordings of those they couldn’t attend.
• 13 past presidents were present to celebrate the Academy’s 25th anniversary, including Drs. Carla Alexander, Bob Arnold, Andrew Billings, Ira Byock, Gail Cooney, Ron Crossno, Laurel Herbst, Michael Levy, Dave McGrew, Sean Morrison, Cameron Muir, Ron Schonwetter and Martha Twaddle.

For the staff, the Annual Assembly is a culmination of a year’s worth of planning, meetings and conference calls. We are excited each year to come to the meeting and come away re-energized by the passion our members bring with them. Although we are still in “recovery mode” from the 2013 meeting (going through notes from on-site meetings and following-up with attendees), the planning for 2014 has already begun.

The 2014 AAHPM & HPNA Annual Assembly in San Diego will be here in just 345 days – mark your calendars for March 12-15!

Laura Davis
Director, Marketing & Membership
AAHPM

Hospice, Hashtags, and Hot Sauce

“I’m sitting on a prop plane that smells like ranch dressing.” I texted my brother on the way home from #hpm13. His reply? “Hold your nose and hope for the best.”

Little did I know that I was the kind soul who provided the fifty seater with the odiferous presence of ranch dressing. The bottle of “Bayou Butt Burner Hot Sauce” that I snagged in New Orleans as a souvenir for my husband apparently could not withstand the pressure of my several journals worth of CME. That bag, saturated with seven dollars worth of ranchy, bayou goodness, still sits in the garage waiting for me to clean it up, a memory of a wonderful trip to New Orleans with an equally wonderful group of people.

On reporting on my trip, my boss said, “Yeah, it’s nice to go to those things. They’re energizing, but nothing ever comes of them in practice.” I agree in part; it IS nice to attend AAHPM’s annual conference. My goal for this year’s post-conference blues is to pick three areas of my home hospice practice in need of attention, and improve on them based on what I learned this year at AAHPM’s national conference.

So where to begin? First off, in trying to rehash tidbits for colleagues, I found myself searching my brain for tips, quips, or pearls handed to me this week. But where were they? As I sat, pondering, twirling my achy thumbs, it came to me.

Twitter.

As a TweetPro for this year’s conference, my tidbits are all on my twitter profile. I tweeted everything I heard that stood out to me, favorited others’ tweets, and retweeted the gems from the seminars I couldn’t attend. Now, they’re all there for me to savor. Pearls of wisdom, line by line, in 140 characters or less.

In all honestly, I took a lot of grief for being a TweetPro. A lot of people just don’t get it. Friends of mine from other sectors of life took offense to my overhaul of their twitter feed. My own family members texted me messages of hospice and palliative medicine exhaustion! But there were far more who did get it, who learned a thing or two, and who thanked me for the record-keeping. The TweetPro title encouraged us to spread the twitter-love to all those wishing to try, which allowed for fast information sharing and extensive networking. Within sessions, the role focused my mind on the topic being discussed, allowed me to engage quickly (and quietly) with others in other rooms and other states, answer questions, ask questions, and solidify the knowledge I was recording. Live tweeting the conference amplified my experience within the assembly, not only academically but socially as well.

Here comes the hard part. Now that I have the knowledge recorded permanently for the world to see, I have to figure out how to make it useful closer to home. I could just rest, knowing I’m a bit smarter now and that my CME hours are climbing, but that does nobody but me any good. I figure I can best benefit my patients by sharing the HPM love with my team of nurses, social workers, and chaplains.

Perhaps the best thing to come of my time in New Orleans was the time away from work to reflect on my patients and my experiences, both personal and professional, and how they affect me as a person and as a physician. In an attempt to share some of what I learned, I aim to be more supportive of my team and more accountable to my families. This is the type of goal that is fueled by the energy provided by both the AAHPM members and assembly.

Thank you to everyone who attended the AAHPM Annual Assembly in New Orleans this year. Each person in attendance helped me recognize that there are thousands of us who share in the same passion, and that it’s a passion worth fighting for.

Now, if you’ll excuse me, my practice, like my bag, waits patiently to be cleaned.

Bethany C. Calkins, MD
@MickeyMD913