What would the most effective palliative care physician's training entail?
As a highly multidisciplinary field, hospice and palliative care can require a broad range of medical training (pharm, physio, psych, geriatrics, medicine, regional/neuraxial anesthesia, ethics and humanities.)
Actually, like the rest of medicine, H&PM requires the management of a broad range of information, priorities and treatments. Unlike in House, M.D., the physician actually does very little of it all.
What the physician does have to be good at is figuring out what a patient needs, and then getting that for them when they need it, e.g., interventions that physicians don't directly do: physical therapy, occupational therapy, speech and language therapy, social work, chaplaincy, PICC line placement or evaluation for PICC line placement, and physician interventions, which are generally specialty-specific (so, you either DIY, or you refer to someone else who does that): biopsy or evaluation for biopsy, surgery or evaluated for surgery, PEG placement or evaluation for PEG placement, chemotherapty or evaluation for chemotherapy, radiatiotherapy or evaluation for radiotherapy, etc. There are some 'tweeners, investigations performed by techs and/or physicians, but interpreted by physicians: surgical/cyto- pathology, EEGs, EPs/NCSs/EMGs, imaging, etc.
So, just because you don't actually perform an intervention/investigation, doesn't mean that you're not qualified to take care of the patient who needs it. You just need to figure out what your patient needs and know how to get it for them when they need it. Everybody can prescribe medication for symptom control.
Plus, physicians taking care of these patients need to have a clear sense and ability to communicate effectively about the multi-factorial nature of conceptualizing and weighing risks (IMHO particularly of iatrogenesis, especially in compromised patients) versus benefits, all weighed against and within the value-system of the patient/family, along the dynamic spectrum of interventions, co-morbidities and prognoses.
What medical background is best equipped to fully serve this patient population?
See above, and, so I think a broad one.
Similarly, with so many types of training eligible for palliative care fellowship/boarding a wide range of variability occurs in these physicians abilities after this one year fellowship.
The knowledge and skills in H&PM fellowships are mainly communication interventions for patients, families and other health care providers, designed to match treatments to goals of the patient, as well as symptom-control interventions.
What path of training will encompass the most beneficial exposure/education?
See above, and so, I think a broad one.
Who would you want to head up your family member's palliative care?
Someone with strong social/emotional intelligence, breadth/depth of thought about about the human condition, great communication-intervention skills, solid interdisciplinary team leadership experience, and broad patient-care experience.
I think most physicians from the sponsoring specialties receive the kind of broad, patient-care management experience I'm talking about.
Though sometimes I wonder, out of my own ignorance, about the amount and type of direct, patient-contact experience within the radiology side of things, even those from rad onc, and interventional. Maybe someone with more knowledge about the clinical training pathways within radiology can comment.
Plus, the kinds of people drawn to subspecialty training in H&PM, generally have strong social/emotional intelligence, a sense of the humanities, and thus seek out extra training in these skills, and pay particular attention to the interesting and troubling cases in their training that lend themselves to a palliative approach.
