Archive for May, 2015

Amy Frieman, MD – Inspiring Hospice and Palliative Medicine Leaders Under 40

This post is from one of the Inspiring Hospice and Palliative Medicine Leaders Under 40. Amy Frieman, MD, was selected based on her involvement in AAHPM, educating others about hospice and palliative medicine, participation in charitable work, and mentoring of students or residents. The honoree was then asked who inspired her over the course of her career. We are sharing some of her answers in this post. Check back regularly for posts from other leaders.

Who has most influenced your work in hospice and palliative medicine and what impact has he or she had?
Dr. David Muller, Dean of Medical Education for the Icahn School of Medicine at Mount Sinai, has most influenced my work, not only in hospice and palliative medicine, but as a physician. Dr. Muller was the Director of the Mount Sinai Visiting Doctors Program when I was a resident at Mount Sinai and later when I was an attending. I have had the amazing opportunity to call him both a mentor and a friend. Making house calls with Dr. Muller, I immediately understood that he was the type of physician that I would strive (and continue to strive) to become. He clearly recognized the person behind the list of medical diagnoses. He listened more than he spoke, and his presence in itself was a comfort to his patients and their families. As a resident, on one of my first home visits with Dr. Muller, I remember visiting a patient with dementia and spending the vast majority of the visit seated in the living room, speaking with the patient’s wife. Initially, I wondered where the patient was and when we would examine him. As Dr. Muller continued to provide support to the patient’s wife, I realized that this would be the most important part of the visit that day. This was the first time that I truly recognized that doctoring comes in many different forms. Dr. Muller also encouraged me to become involved with medical education and helped me to foster my interest in medical humanities.

Where do you see yourself in 5 years?
In five years, I see myself continuing to expand palliative care services at Meridian Health. While palliative care has become an important part of the culture of our inpatient and post-acute care facilities, I want to continue to work to build upon our outpatient palliative care services. I plan for our home-based palliative care program to continue to expand. In addition, I envision our office-based palliative care practice extending to multiple locations. As Meridian continues to actively address health care reform, my goal is for palliative care to be firmly entrenched within our system’s population health management initiatives, our accountable care organization (ACO) and our clinically integrated network. As a patient advocate, my vision is that in five years, the delivery of palliative care at Meridian will be seamless, and that all patients who would benefit from palliative care will have access to these services no matter where they are in the care continuum. In addition to continuing my work at Meridian, I plan to become more active on the statewide level in New Jersey, advocating for increased use of palliative care and hospice services for our vulnerable patient population.

What is the best advice you have ever received?
The best advice that I have ever received is to “choose to be happy.” Growing up, this was a message that I frequently heard from my parents. I believe it is even more pertinent to me as an adult, particularly now as a hospice and palliative medicine physician. Being surrounded by patients with serious and often terminal illness, I have tried to embrace this advice. I make a conscious effort to recognize all of the gifts that I have in my life every day, and to be grateful for each and every one of them. I look at my amazing family and friends, my good health that allows me to leave the hospital and go for a run, my rewarding career, and I know that I have been blessed in life. Rather than focusing on the negative and allowing myself to become discouraged by difficult issues, I try to choose to be happy. Though I am certainly not always successful in this mission, more often than not, I find that happiness is a mindset and a way of looking at life.

Robert Crook, MD FACP – Inspiring Hospice and Palliative Medicine Leaders Under 40

This post is from one of the Inspiring Hospice and Palliative Medicine Leaders Under 40. Robert Crook, MD FACP, was selected based on his involvement in AAHPM, educating others about hospice and palliative medicine, participation in charitable work, and mentoring of students or residents. The honoree was then asked who inspired him over the course of his career. We are sharing some of his answers in this post. Check back regularly for posts from other leaders.

Who has most influenced your work in hospice and palliative medicine and what impact has he or she had?
I especially want to recognize my wife, Annette, for her seemingly infinite love, support and sacrifices during this journey.
I am grateful to have worked with many skilled physicians, nurses, social workers, and chaplains who have taught me much and shared their passion for palliative care. I thank the Dominican Sisters of Hawthorne who introduced me to the field and for the privilege to work alongside them as an aide at Holy Family Cancer Home while in college. I appreciate Paul Mihacevich, Sister Luke, and all the nurses sharing with me their skilled care for dying patients and their families. I am grateful to the Hospice of Northwest Ohio for teaching inquisitive medical students and allowing me to learn from a master in compassion, Dr. Marsha Paul. It was an honor to learn under Dr. Michael Harrington during residency at Case/MetroHealth and I am appreciative for all the extra time he spent mentoring me. I give special thanks to the Hospice of the Western Reserve and Dr. Chuck Wellman for always being a resource over the years. My former partners Dr. Ann Moore and Dr. David Tribble have forever positively influenced practice. I appreciate the time, active mentoring, and friendship of Dr. Dan Masion, who taught me many things including some of the soft skills which were seemingly quite hard. Lastly, I am thankful for my current partners and the incredibly skilled and supportive team at Mount Carmel, especially Lori Yosick, Dr. Phil Santa-Emma and Dr. Walt Ferris.

Where do you see yourself in 5 years?
I hope to serve where called and where my gifts best match the world’s need.

What is the best advice you have ever received?
“Watch your thoughts, they become words. Watch your words, they become actions. Watch your actions, they become habits. Watch your habits, they become your character. Watch your character, for it becomes your destiny.” -Frank Outlaw

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

Highlights of the May Issue of the Journal of Pain and Symptom Management
Listed below are a few articles from the most recent issue of the journal:

Promoting Evidence in Practice

Octreotide for Malignant Bowel Obstruction: Commentary on Currow et al.
Sebastiano Mercadante

Original Articles

Double-Blind, Placebo-Controlled, Randomized Trial of Octreotide in Malignant Bowel Obstruction
David C. Currow, Stephen Quinn, Meera Agar, Belinda Fazekas, Janet Hardy, Nikki McCaffrey, Smon Eckermann, Amy P. Abernethy, and Katherine Clark

Measuring End-of-Life Care and Outcomes in Residential Care/Assisted Living and Nursing Homes
Sheryl Zimmerman, Lauren Cohen, Jenny van der Steen, David Reed, Mirjam C. van Soest-Poortvliet, Laura C. Hanson, and Philip D. Sloane

Quality of Life and Cost of Care at the End of Life: The Role of Advance Directives
Melissa M. Garrido, Tracy A. Balboni, Paul K. Maciejewski, Yuhua Bao, and Holly G. Prigerson

Review Article

Measuring Experience with End-of-Life Care: A Systematic Literature Review
Jessica Penn Lendon, Sangeeta C. Ahluwalia, Anne M. Walling, Karl A. Lorenz, Oluwatobi A. Oluwatola, Rebecca Anhang Price, Denise Quigley, and Joan M. Teno

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

Laura Gelfman, MD, MPH – Inspiring Hospice and Palliative Medicine Leaders Under 40

This post is from one of the Inspiring Hospice and Palliative Medicine Leaders Under 40. Laura Gelfman, MD, MPH, was selected based on her involvement in AAHPM, educating others about hospice and palliative medicine, participation in charitable work, and mentoring of students or residents. The honoree was then asked who inspired her over the course of her career. We are sharing some of her answers in this post. Check back regularly for posts from other leaders.

Who has most influenced your work in hospice and palliative medicine and what impact has he or she had?
My experience caring for Ms. R, an older woman with metastatic breast cancer and severe post-herpetic neuralgia, continues to shape my approach to palliative medicine. I cared for Ms. R throughout my clinical fellowship, through multiple hospitalizations and ultimately, I cared for her at home until she died.

These experiences taught me the importance of finding ways to ensure Ms. R’s voice was heard throughout her illness, which slowly diminished Ms. R’s closely guarded and highly valued independence. When her oncologist offered her more chemotherapy, Ms. R could not say “yes” because she suffered from her previous chemo and she could not say “no” because she was afraid of what the future might look like. Her sons and her doctors all agreed that her decision to not decide was a decision that we would support, all the while working to control her symptoms.

Our symptom management focused on the ebbs and flows of her somatic and neuropathic pain, opioid-induced constipation and acute delirium, each critical to her care. This required effective communication and care coordination among her care team, including her oncologist, homeopathic doctors, family and home care team. I witnessed firsthand the devastating effects and unmatchable joys of caregiving. Through my continued relationship with her family, I have come to appreciate the waves of bereavement and the meaning of sharing memories. When I look back at my fellowship, I realize that Ms. R taught me the fundamental tenets of palliative medicine, and the intense satisfaction and privilege of providing our care to patients with serious illness and their families.

Where do you see yourself in 5 years?
In 5 years, I plan to transition from a mentored K23 funded investigator to an R01 funded independent investigator whose research improves the care of older adults with advanced heart failure. Under future NIH career development funding, along with my Hartford Centers of Excellence Collaborative Pilot Award, I will design and pilot test an intervention to improve the communication skills among heart failure clinicians. With future R01 support, I will conduct a randomized controlled trial to test the intervention. Improving communication skills of heart failure clinicians has the potential to better outcomes of patients living with heart failure by aligning treatments with their goals of care. I will continue to leverage national funds to build a coalition of both funders and key stakeholders within HPM as well as outside of HPM to be able to move the field forward. I will use these awards to ensure that I improve the quality of care for patients living with serious illness and their families, and advance the field of HPM.

What is the best advice you have ever received?
Throughout my childhood, when I faced a challenging decision or problem, my parents encouraged me to take a step back with the simple phase that my father learned in the Navy “KISS: Keep it simple stupid.” To this day, I remind myself of this advice as I sit down to write a grant or a manuscript, to break bad news to a patient or a family member, teach medical students the fundamentals of pain management, or encourage a fellow to practice a new communication skill. By breaking down a complex problem into smaller pieces, I have come to realize that these challenges become more surmountable, not only for me as a clinician, educator or researcher, but for patients, families, learners, trainees and mentees.

Hunter Groninger, MD FAAHPM – Inspiring Hospice and Palliative Medicine Leaders Under 40

This post is from one of the Inspiring Hospice and Palliative Medicine Leaders Under 40. Hunter Groninger, MD FAAHPM, was selected based on his involvement in AAHPM, educating others about hospice and palliative medicine, participation in charitable work, and mentoring of students or residents. The honoree was then asked who inspired him over the course of his career. We are sharing some of his answers in this post. Check back regularly for posts from other leaders.

Who has most influenced your work in hospice and palliative medicine and what impact has he or she had?
One of my favorite aspects of our field is the diversity of the professional base: people don’t come to HPM because they love a particular organ system; they come because of their own personal and professional stories. Because of this, so many rich experiences inform folks moving into the field. I can think of a dozen individuals who have significantly impacted my work and it would be difficult to choose the one who has influenced me the most.
But here is one of those rich experiences that stands out: as a fourth year medical student, I did a rotation in palliative care with Dr. Daniel Fischberg. One day, we were rounding on a patient, an elderly woman dying in an intensive care unit. Her large family was gathered around the bed, trying to accept the inevitable decline of this matriarch. Understandably, they were so incredibly sad. It was palpable in the room. I remember feeling paralyzed, like there was nothing more to be done that might help them through this time. Then, in the middle of talking with some of her children, Dan gently moved the conversation to life before this hospitalization. What did she like to do for fun? What gave her joy or excitement? Within a few seconds, the room filled with laughter and storytelling. The gathering suddenly seemed like a celebration. I was stunned to witness this simple magic, and I knew I wanted to be able to help patients and families just like this.

Where do you see yourself in 5 years?
I see myself exactly where I am now: serving the community of the Washington, DC, metro area. When I arrived here in 2006, the city of Washington, DC, had one of the lowest hospice utilization rates in the nation and one of the highest rates of in-hospital death. Patients and families were just beginning to learn of the supportive benefits that palliative care can provide. Since then, many HPM clinicians have worked hard to change this for the better, but there is much more to do. I aim to see palliative care deeply implemented into the inpatient and outpatient fabrics of my hospital; our current project to integrate palliative care upstream with advanced heart therapies is one part of that. I also want to create strong partnerships with community-based HPM providers to make this care truly seamless. And we need to study what we implement so we can always improve and extend these benefits.

What is the best advice you have ever received?
Founder of the Zen Hospice Project Frank Ostaseski has developed five precepts that he uses to teach caregivers of the dying. They are all important to me, but one in particular I find myself practicing many times a day: find a place of rest in the middle of things. Working with seriously patients and their families could not be more rewarding. It can also be very challenging work. Then put this hard work in the context of the rest of life – family, friends, financial responsibilities, hobbies, spiritual life – and it can be tricky not to feel pulled in too many directions. I remember talking with Frank about this specific precept. His suggestions were simple: pause and breathe before entering a patient’s room; enjoy a red light instead of being frustrated by the commute; when you wash your hands dozens of times on hospital rounds, just focus on washing them, and let your mind relax rather than race from thought to thought. When I follow this advice, I feel focused, energized, and present to these special moments with our patients. I can bring more to my work, but I also take away more from these rich experiences and look forward to the next encounter.