http://www.aahpm.org/apps/blog/?p=1142 Physicians caring for patients with serious illness. Thu, 07 Feb 2013 01:31:00 +0000 http://wordpress.org/?v=2.9.1 hourly 1 http://www.aahpm.org/apps/blog/?p=1142&cpage=1#comment-8690 alison lauber Wed, 13 Jul 2011 17:16:36 +0000 http://www.aahpm.org/apps/blog/?p=1142#comment-8690 I have found it difficult with most oncologists to even consider consultations with palliative care,and frequently they only refer to hospice hours or days before death. This is not to say all in the discipline, just the majority that I have worked with. After the NEJM article, I made a major presentation to our CA committee and suggested that as each new CA patient was diagnosed that we have a meet and greet consultation, so that patient's knew about us, and that we were here to make their treatment to cure easier and provide support for mind and body for them and their families. While the presentation was well received, the referral patterns didn't change at all! I now focus on teaching the Junior medical students what Palliative medicine really is and have created mnemonics( every discipline has to have them, right?) And when asked by patient and/or family what I can do for them? I use the analogy of the Hostage Negotiator. I am there to help the patient negotiate with their family and medical team,(PCP and frequently long list of dueling consultants) shifting through all the confusing information, and do my best to get them the best possible deal in terms of comfort and solace, both physical, spiritual and existential(although I don't use the big words. I'm, thinking of getting hats and windbreakers printed. What do we say to politicians, mandate third party payors to pay us and insist that this is a necessary service that all Cancer centers need to provide! Would you want your pain management to depend on the average surgeon, and many oncologists think Zofran is the sin qua non for nausea. Again I don not mean this to bash another group of excellent specialists. Oncologists never give up in a field that would depress many otherwise fearless folks, and because of this cure rates have improved. Surgeons have to have nerves of steal to operate when they are swimming up stream against the current. Each of our chosen disciplines at times gives us a tendency toward tunnel vision, so we must always listen to each other. But it must be a two way street. We cannot always be the ones to listen and respond, the other side has to do the same! I have found it difficult with most oncologists to even consider consultations with palliative care,and frequently they only refer to hospice hours or days before death. This is not to say all in the discipline, just the majority that I have worked with. After the NEJM article, I made a major presentation to our CA committee and suggested that as each new CA patient was diagnosed that we have a meet and greet consultation, so that patient’s knew about us, and that we were here to make their treatment to cure easier and provide support for mind and body for them and their families. While the presentation was well received, the referral patterns didn’t change at all!
I now focus on teaching the Junior medical students what Palliative medicine really is and have created mnemonics( every discipline has to have them, right?) And when asked by patient and/or family what I can do for them? I use the analogy of the Hostage Negotiator. I am there to help the patient negotiate with their family and medical team,(PCP and frequently long list of dueling consultants) shifting through all the confusing information, and do my best to get them the best possible deal in terms of comfort and solace, both physical, spiritual and existential(although I don’t use the big words. I’m, thinking of getting hats and windbreakers printed.
What do we say to politicians, mandate third party payors to pay us and insist that this is a necessary service that all Cancer centers need to provide! Would you want your pain management to depend on the average surgeon, and many oncologists think Zofran is the sin qua non for nausea. Again I don not mean this to bash another group of excellent specialists. Oncologists never give up in a field that would depress many otherwise fearless folks, and because of this cure rates have improved. Surgeons have to have nerves of steal to operate when they are swimming up stream against the current. Each of our chosen disciplines at times gives us a tendency toward tunnel vision, so we must always listen to each other. But it must be a two way street. We cannot always be the ones to listen and respond, the other side has to do the same!

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