Archive for February, 2010

Eating Out in Boston: AAHPM Member Edition

Nearly 2,300 people are expected to descend on Boston in the next few days for the AAHPM & HPNA Annual Assembly, and the burning question on everyone’s mind is … where am I going to eat? Actually, with the extensive array of educational sessions and networking opportunities planned for nearly every hour of the day, food is more likely to be something of an afterthought. There are many dining options available beyond the nearest McDonald’s or room service, however, so be sure to take advantage of the eclectic range of eateries in Boston. With recommendations ranging from casual cafes to fine dining, 10 AAHPM members who are Boston locals have graciously shared their favorite restaurants in the area (yes, some are duplicates, but that is all the more reason to visit these popular restaurants!).

The scrumptious sandwiches are among the top selections at the Parish Cafe. Photo courtesy of The Parish Cafe.

1. Mooo – Primarily a steakhouse, Mooo has well-prepared food, a pleasant ambiance, and excellent service. –Douglas Brandoff, MD

2. South End Buttery – Not over the top expensive, the South End Buttery is my new favorite restaurant and serves a delicately flavored menu, full of variety. Just a 1.1 mile walk from the convention center! –Joanne Wolfe, MD MPH

3. Legal Sea Foods – One of the best fish places in Boston, though expensive. If you’re on a budget and looking for something edible and quick, consider the Food Court in the Prudential Center just across the street. Also try Jasper White’s Summer Shack a block away, which enjoys considerable fame (as well as a raucous atmosphere). –J. Andrew Billings, MD

4. Abe & Louie’s – I love this old-fashioned steak house, just a short walk from the convention center! –Janet Abrahm, MD

5. Legal Sea Foods or Sel de la Terre are two of my favorites—there are so many great restaurants in the area that no attendee should suffer a bad meal! –Jim Baker, MD

6. Sel de la Terre – Really convenient and a little fancy, Sel de la Terre offers delicious food inspired by southern France country cooking. –Rick Goldstein, MD

7. Rocca – This South End eatery offers a friendly atmosphere and excellent Italian food. –Susan D. Block, MD

8. Parish Café – My favorite for lunch with out-of-towners, this café has scrumptious, savory sandwiches. The Cactus Club – Right across the street from the convention center, the Cactus Club boasts the best margaritas in town! Finale is decadence defined. As we in the palliative care community know well, “life is short, so eat dessert (first)!” Small dinners are offered as a preclude to dessert, the main event here! –Mary Buss, MD

9. The Other Side Café – Vegetarian choices, hip atmosphere, and a surprisingly good beer selection are found at this café, less than a 10-minute walk from the Hynes. –Brian McMichael, MD

10. Addis Red Sea Restaurant – Located in the South End at 544 Tremont Street, visit this restaurant for authentic Ethiopian cuisine, friendly wait staff, and a nice ambiance. -Craig Blinderman, MD

Don’t see a favorite place on the list? Share with other attendees your thoughts on where to eat! Happy dining.

-Katie Macaluso, AAHPM Assistant Editor

It’s not too late…

… to find yourself in Boston, MA, for the AAHPM & HPNA Annual Assembly March 3-6! The Opening Reception is now less than two weeks away, but there’s still time to join more than 2,200 of your colleagues at the Assembly—click here for more details and to register.

Already planning to attend? There’s so much to do in Boston—just click on the video below, courtesy of the Greater Boston Convention & Visitors Bureau, for a brief look at the many historical, educational, and cultural opportunities awaiting us in Boston.

The convention center and host hotels are within walking distance of major attractions such as Fenway Park, the shops and restaurants in the Prudential Center, Newbury Street, the financial district, and the Charles River. Where will you be going? Feel free to leave a comment with ideas for where to visit during free time in the evenings or following the Assembly.

See you in Boston!

-Katie Macaluso, AAHPM Assistant Editor

Student Perspective: Our Identity as HPM Physicians

“You want to go into what?

Explaining to family and friends exactly what palliative medicine is and why you’re interested in it can be a daunting task. In my experience, the looks usually go from confused to dismayed to confused again. “How could you possibly want to do something so…morbid? You have to be a very special person to do that.

What about all the other doctors, the ones who aren’t in hospice and palliative medicine (HPM)? Do they not deal with their own fair share of morbidity and mortality? Sure they do, upon occasion, but they usually cure their patients…right? Savvy surgeons extract a patient’s appendix to cure appendicitis, while insightful internists prescribe antibiotics to cure an infection. But somewhere down the line, the patient who was just cured will get sick again, and maybe next time it’ll be with chronic obstructive pulmonary disease or congestive heart failure. Even if we do eventually discover a cure to those illnesses, others will take their place.

The mortality rate is—and forever will be—100 percent. If the purpose of physicians is to cure everyone of everything, then in the end we all fail.

Fortunately, doctors do much more than cure. We are in the business of healing, and healing does not always mean curing, nor does it even necessarily mean affecting a physical improvement. Physicians may heal in other ways too, encouraging emotional, mental, and spiritual convalescence in patients and their families.

In fact, it is in these “alternative” forms of healing that the HPM physician shines.

Perhaps you can’t cure Mr. Smith’s cancer, but you can help him cope with the many facets of his illness, including his pain and depression, and his wife’s inability to care for him alone. Mrs. Jones may be in a coma, but you are still there to advocate for her and answer her children’s questions.

While some other doctors rush around trying to fight sickness, the HPM physician lives by this quote from Maimonides: “The physician should not treat the disease but the patient who is suffering from it.”

Physicians are here to treat people, not symptoms or germs or diagnoses. It is our greatest responsibility and privilege. And who needs such compassionate treatment more than the critically ill and the dying?

Although it’s true that it is not easy to care for patients who may suffer and die, we must take that risk to be effective physicians. Furthermore, to heal others, we must come to terms with not always being able to cure them and ultimately not being able to cure ourselves. This is a difficult yet rewarding lifelong journey. It is what HPM is all about.

HPM is a wonderful field that I feel honored to have chosen as my own. If you are also a student considering HPM, I highly encourage you to attend the Medical Student Forum at the AAHPM Annual Assembly on Saturday, March 6, 8 am – 4 pm. It may help you answer all the whats, whys, and hows you are bound to be asked by family and friends.

By Jacqui O’Kane, GA-PCOM, OMS-II

This is me!

What Does the American Civil War Teach Us About Contemporary Death and Mourning?

Join the Humanities SIG at the Assembly in Boston for an illuminating discussion of the award winning book, This Republic of Suffering, on Saturday, March 6, 12:15 – 1:15 pm. Among the questions we’ll discuss:

This Republic of Suffering

Prior to the Civil War, the end of life process commonly occurred at home, with family, the family physician, clergy, community members, and others with long-standing relationships providing care and support. Funerals were commonly held at the local church, providing family, extended family, friends, and community members a place to express and share their grief. Custom also provided for public mourning, allowing the bereaved to openly express their grief, and for others to recognize and offer support. Circumstances of the Civil War – which in today’s population would equal 6 million deaths – profoundly changed these customs.

In contemporary America, when asked to describe how one wishes to spend one’s final months and days, respondents will often describe a scenario resembling a pre-Civil War process. Yet this ideal is frequently not achieved. In what ways does the contemporary end of life process reflect the death, realizing, and mourning processes experienced by many during the Civil War, and what interventions can end of life care practitioners consider to achieve the goals of the individual, their family, and community in such circumstances?

Come share your thoughts, learn from others, and take away new insights to apply in your practice. See you there!

Charlie Sasser & Karen Whitley Bell

AAHPM President Reacts to Misleading HPM News Article

AAHPM submitted the following letter to US News & World Report in response to Dr. Bernadine Healy’s “On Health” column from the recent February 2010 Special Issue – “Aging Well” – which included some misleading comments about hospice and palliative medicine. We encourage AAHPM members to post their thoughts at the end of the article in the Reader Comments section.

Letter to the Editor

US News & World Report

February 12, 2010

Bernadine Healy is correct when she says that patients need to be informed about their health care, including end-of-life care (On Health, February 2010 – Special Issue: Aging Well). As a doctor who specializes in hospice and palliative medicine, I have always urged patients to have living wills and to discuss their wishes for end-of-life care with their doctors and family members.

But some information Dr. Healy presents about palliative medicine is simply incorrect, and suggests that expanding the availability of palliative medicine will limit options for people with serious illness. Exactly the opposite is true.

Palliative medicine is a board-certified medical specialty that focuses on relieving suffering and providing support and care coordination for patients with serious illnesses, regardless of age or prognosis, or whether curative treatments are being given. Many of our patients recover from their illnesses and credit palliative medicine with making grueling curative treatments bearable.

Studies show that palliative medicine decreases hospital admissions, and Dr. Healy fears this goal of health care reform will result in premature death for patients with chronic and incurable illnesses. Palliative medicine keeps patients out of hospitals by relieving their symptoms and coordinating their out-patient care, which often reduces the need for hospitalization. It’s better for the patient and the family. And, yes, it saves the system money.

Dr. Healy refers to “so-called terminal sedation” and seems to suggest that this is one way that hospice care – a specific type of palliative care – might be used to hasten death, and cut costs. I believe she is referring to “palliative sedation.” Palliative sedation is used – rarely – to bring relief to patients already near the end of life whose pain and suffering are overwhelming and otherwise uncontrollable. When it is necessary, and a patient chooses it, palliative sedation can enable us to fulfill our promise to help our patients face death with some comfort and control.

My colleagues and I chose to practice palliative medicine to ease pain and suffering, and give patients more control over their care. The health care reform debate has brought attention to our specialty – not always accurately. We want people – especially those who may need the care we provide – to have the facts. They can find them at www.PalliativeDoctors.org.

Gail Austin Cooney, MD

President

American Academy of Hospice and Palliative Medicine

Aerosmith, The Cars, and now…The 2010 Assembly Plenaries: Boston Rocks!

With the two weeks and counting to Annual Assembly we have a record number of pre-registrants all descending on the Hub. My HPNA co-chair and fellow Bay Stater, Pat Coyne, and I promise you a wicked good Assembly. We have a veritable smorgasbord planned and I’ve been given an opportunity in this blog to whet your appetite for the coming feast. Here I’ll focus on our plenary and Special Interest Group (SIG) Symposia.

First up, Thursday morning will be Lynne Hughes. Her plenary, “Comfort Zone Camp”, will focus on bereaved children. Inspired by her own experiences of loss as a child, Ms. Hughes is the founder of the Comfort Zone Camp (http://www.comfortzonecamp.org/), the largest bereavement camp for children in the nation. These camps offer a safe and healing bereavement experience for children that have lost a loved one. I’m particularly pleased that Ms. Hughes will be our opening plenary speaker, putting our focus from the start on the care of children. The clinical care of children will receive an unprecedented place of prominence at this year’s Assembly. This year’s new pediatric track will ensure that those that care for children will always have an educational opportunity focused on their needs throughout the Assembly.

Next up on Thursday, we are honored to have Roshi Joan Halifax of the Upaya Zen Center (http://www.upaya.org/about/index.php) speak on “Compassionate and Mindful End-of-Life Care: a Relational-Contemplative Approach for Clinicians.” Roshi Halifax is a Buddhist teacher, Zen priest, and anthropologist. She has worked with the dying and those who care for them for over 35 years. Take note that Roshi Halifax will also be teaming up with some very talented colleagues (Anthony Back, Susan Bauer-Wu, and Cynda Rushton) for an exceptional preconference workshop, “The Science and Practice of Contemplative Interventions for Palliative Care Clinicians” (P8).

Last year we introduced SIG Symposia as a new educational offering to bring special attention to our vibrant and varied SIGs. These symposia let our SIG members tackle weighty issues in a dynamic forum. They were so enthusiastically received last year that we are pleased to bring them back in force this year. We had a tremendous number of submissions from the SIGS and are pleased to offer the following choices on Thursday afternoon:

  • Fellowship Directors: “Peer Mentoring: An Innovative Model for Professional Advancement in Hospice and Palliative Medicine”
  • Physicians in Training: “Asking Tough Questions: Career Advice from the Experts”
  • Ethics: “Is It Time to Pull the Plug on the Principle of Double Effect?”
  • Ethics: “Palliative Medicine and Bioethics Interface: Collaboration and Cooperation or Codependency and Conflict”
  • Cancer: “What is ‘Palliative Chemotherapy?’ Perspectives from Oncology, Palliative Care, and Hospice”
  • Humanities: “Just Being: An Introduction to Mindfulness and Its Role in Tending to the Dying”
  • Pediatrics: “Decision-Making at the Extremes of Pediatric Palliative Care”
  • Long-Term Care: “Hospice and Non-Hospice Models of Palliative Care Delivery in Long-Term Care”
  • Osteopathic: “Osteopathic Manipulative Medicine in Palliative Care

If, like me, you haven’t figured out how to clone yourself to attend more than one of these great sessions, consider purchasing the audio recordings and/or flash drives of handouts. Both of these will again be available for purchase at the Assembly. I’ve found these items a great way to get the most out of the Assembly and not sweat it when there are two or more sessions I feel I just can’t miss. Which if we’ve done our job right, should be happening frequently!

On Friday morning we’ll be hearing from Deborah Grassman (http://deborahgrassman.com/) the Director of Hospice and Palliative Care at Bay Pines VA Medical Center during her plenary, “Wounded Warriors: Their Last Battle.” Ms. Grassman has been a hospice nurse for over 25 years in a VA hospital setting. Her new book, Peace at Last, has the goal of helping veterans, and those that care for them, to appreciate the impact of war and military culture on their living and their dying.

Do you worry about barriers to safe and effective pain management for your patients? How about the epidemic of prescription drug abuse in the US? The need to rationally balance concerns about both of these critical health care issues will be the topic of Dr. Aaron Gilson’s plenary, “A REMS for Long-Acting Opioid Analgesics: Anticipated Impact on the Dual Public Health Issues of Non-Medical Use and Patient Pain Care.” Dr. Gilson is the director of the US program of the Pain and Policy Studies Group at University of Wisconsin (http://www.painpolicy.wisc.edu/). He has dedicated his career to improving policies that affect pain management for people with cancer and other chronic conditions. Dr. Gilson’s perspective will be invaluable to all of us in hospice and palliative care. He is uniquely positioned at the forefront of this crucial area that has a direct impact on the care we provide.

On Saturday our plenary focus shifts to the science of what we do. Starting us off, once again, will be Drs. Nate Goldstein and Wendy Gabrielle Anderson. Our returning Dynamic Duo will present their “State of the Science” plenary. Don’t miss this opportunity to hear Nate and Wendy’s thoughtful interpretations of the latest research that may just change the way you provide care. Always an Assembly highlight, I’m absolutely delighted to have Nate and Wendy back this year.

Our closing plenaries on Saturday afternoon keep the focus on science. I’m ecstatic that Dr. Holly Prigerson of the Dana-Farber Cancer Institute (http://www.dfhcc.harvard.edu/membership/profile/member/38/0/), has agreed to join us to present her plenary on “End-of-Life Care as an Illusion—Wish Fulfillment: But Whose Wishes and Why?” I have to confess that when I look back over the last few years of research in our field, there is nobody I can name whose work has fascinated me more than Dr. Prigerson. The lessons her work teaches us about communication, coping and processes of care for the seriously ill and dying are profound.

Make sure your travel agent knows how essential it is for you to make it to our closing plenary. You won’t want to miss Dr. Jeannine Brant’s talk, “Strategies for Breathlessness at the End of Life.” Dr. Brant is an oncology clinical nurse specialist at the Billings Clinical Cancer Center as well as a master clinician and educator. She is just the person to update us on the science and best practices for managing dyspnea, arguably one of the most critical jobs we are called upon to do.

There you go. I look forward to hearing your thoughts on our plenaries and SIG symposia either here online or in Boston. Be there! Aloha.

Daniel Fischberg, MD, PhD

AAHPM Program Planning Committee Chair

The Queen’s Medical Center, Honolulu

The John A. Burns School of Medicine of the University of Hawaii

Is this thing on?

I’m thrilled to welcome you to the official AAHPM blog. Many of you are frequent blog contributors and followers already, as there are several resources available within our online community. My hope is that AAHPM will provide yet another place where we can all congregate and connect with one another. With the successful use of Facebook, Twitter, and other social media, AAHPM members are now more aware of important issues such as major proposed drug changes by the FDA which first surfaced in social media circles this past year. It is clear that there is a broader community that could benefit from a greater AAHPM presence on the Web and we are pleased to officially enter the blogosphere!

I expect this will become another gathering place for anyone interested in the field to converse about articles, educational sessions, and issues important to you and your work. We hope to attract members and non-members—all are truly welcome. I anticipate that this blog and others like it will continue to work together to raise awareness about the incredible advancements and critical issues occurring within the field of hospice and palliative medicine.

The timing of our online debut is no accident—the Annual Assembly in Boston is just 2 weeks away. Stay tuned as we preview some of the most anticipated events of the Assembly, with the help of more than 20 members who have enthusiastically offered to contribute their thoughts right here on the AAHPM blog.

Have you ever attended a session and left wishing you could continue or start a discussion? Ever been torn between multiple sessions occurring at the same time and wished you could learn more about the ones you missed? Are you unable to attend this year’s Annual Assembly but want to stay connected to the latest developments and critical issues? Be sure to add the AAHPM blog to your favorite bookmarks and join the discussion.

I hope to see you in Boston—and right here as well. Happy Blogging.

-Steve Smith, CAE, AAHPM CEO and Executive Director