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Discussion in 'Hospice and Palliative Medicine' started by oldpro, Oct 16, 2006.

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  1. oldpro

    oldpro MS IV

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    Hi I was a Hospice RN for 9 years and decided to go to Medschool, well Here I am in second year, miss the Patients so much, but look forward to clinicals soon.
    I find the Hospice years have served me well and hope to be a Medical Director for a local Hospice on day. I'm going into FP and think this will be a good path.

    Are there others on this road too?

    Pallative care needs good people! :D

    Hospice is about life not just the end of it, there is time inbetween.

    :luck:
  2. NY Musicologist

    NY Musicologist Career Changer

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    Glad to hear from you, oldpro. I'm a pre-pre-med (starting postbacc next fall, I hope) and a first-time hospice volunteer. Despite my minimal experience, I feel strongly about the importance of hospice and palliative medicine and would very much like to consider a career in this area.

    I'm curious about why you decided to make the switch from nursing to doctoring within the hospice framework. I have had thoughts myself about becoming a medical director for a hospice, but recently I started to wonder what a medical director really DOES--i.e., isn't it primarily an administrative position? I'm not sure I want that. The hospice nurses seem to me to be the foundation of the care team; maybe that's where I should be... :confused: (Mind you, if I weren't considering hospice so strongly, I wouldn't be having this inner debate about nursing vs medicine--I'd go for the latter with its increased autonomy/responsibility--but in hospice, the boundary lines seem drawn differently. I just don't want to spend ten years and a small fortune in medical training only to realize at the end that I really should have been a nurse instead! :)

    Sorry for the long post, but I'll appreciate any thoughts you have re. medical directors, hospice nurses, etc.
  3. signomi

    signomi Amongst the Gravelings

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    I have been accepted to a Palliative Medicine fellowship starting 7/1/07. I am still interviewing though.
  4. drwatson

    drwatson Stern. Stern but fair.

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    Congratulations on your fellowship. Can you talk about what residency program you did and why you choose to do a palliative fellowship?
  5. signomi

    signomi Amongst the Gravelings

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    I did an Internal Medicine residency but I finished a couple years ago. I have worked in private practice doing primary care (sucked) and in hospital medicine. As a night house doc I have a lot of exposure to end of life issues. We have hospice beds in our hospital and we manage any urgent issues for them overnight. Patients always crash at night it seems, with no advance directive. So I spend a lot of time meeting with families and addressing code status and initiating palliative care measures in the middle of the night. I really wish the primary MDs would address it, but that just isn't going to happen.
    I finally decided to apply to some programs with open positions and actually get the formal training. It seems the quality of life for palliative medicine docs is pretty good and they generally seem happy with their jobs.
    It is great that it isn't through ERAS yet.
  6. oldpro

    oldpro MS IV

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    Thanks, a medical Director oversees the Nurses care and cosigns the care plans as well as take on Patients under care for the Hospice at times, Home care hospice patients at time have no primary care Doc or do not want the Doc they have as primary or the primary Doc would like to give the patient to the Hospice Doc to manage. It's better overall for the Hospice team if the Medical Director takes care of the Patient as primary Doc because they sit in on the team meetings and go over care plans and come up with Treatments, also on call it is way better for the nurses since they will know what the Hospice medical director will approve of and what they do not approve of.

    Hospice nurse do have a lot of automony thats why I liked it but you are still not a Doc. I also wanted to to do some other stuff as well so FP to me seems to be a good fit. After 9 years it was time for a break anyway.

    I hope to be a Director or affiliate Doc at one of the Hospices in my Rural area. I may become Pallative Care Certified as an MD too? We will see.

    End of life care to me is the Last year of life not just 6 months, I will continue to work with Medicare and everyone else to educate them in this. 6 months is outdated and not realistic, people need the interventions sooner and should spend the last 12 or so months with decent quality of life, think of yourself, your children, your spose, your mother and father, do not they deserve this kind of care?
    :luck:
  7. NY Musicologist

    NY Musicologist Career Changer

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    Thanks for the information. I really wish a fellow/practicing doc would join us here to offer an insider's perspective...
  8. oldpro

    oldpro MS IV

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    Yes me too it would be fun and we could talk more about the Physician role.:thumbup:
  9. RuralMedicine

    RuralMedicine Senior Member Moderator Emeritus

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    I haven't done the palliative care fellowship but I was fortunate enough to train with a great palliative care mentor as a resident and I now do a fair amount of hospice work. Signomi I'd be interested in your perspectives as you go through fellowship and how much you think it helped versus pursuing with just baseline IM. I have no intentions of doing solely palliative care, hospice or geriatrics so our goals may be different.
  10. signomi

    signomi Amongst the Gravelings

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    Well I start in 8 months! I have a spot in a program, but I am still completing some interviews. It is interesting thus far. I was surprised to see how much the programs value research experience, especially research that could tie into palliative care. I also got the impression they put more emphasis on a well-rounded individual.
    When I am done interviewing I could post a little bit about the places I interviewed.
  11. NY Musicologist

    NY Musicologist Career Changer

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    Good to know about the research desirability. I assume, signomi, that you had some in your portfolio. Was it research that you had conducted during your residency, or...?
  12. oldpro

    oldpro MS IV

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    WOW I'm glad, too many people (even the students at my school) think Hospice is all about Death, it's not, it about Life! We need people in pallitive care that understand that the realm of chronic endstage diseases can also fall into this as well. Good Management of Pain and symptoms can do so much for a Patient. People should be living and getting out of life as much as possible. I know I would want that. Also studies show that even if it seems that it's costing us more in care dollars, it's really not compared to the avioded hospitalizations, uneeded tests, undue emergengies, lost manhours and the lost of the productability of some Patients, yes I know some chronic endstage disease people who worked until the last few weeks, it was what they were happy at. There is a lot Pallitive care can give back to all of us.:idea:
  13. signomi

    signomi Amongst the Gravelings

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    Yes I have basic science research from med school and clinical research on drug toxicology from med school and residency. That seemed to grab their attention since a lot of palliative medicine research these days is evaluating symptom management through drugs and monitoring side effects/tolerability.

    I was actually surprised at the caliber of the programs that called me for an interview. Apparently I am a better applicant than I thought. :laugh:

    At interviews they have been very focused on why palliative medicine and what your career goals in palliative medicine would be. They also want to know what led you to palliative medicine and what makes you unique/what you bring to the table. They asked me about outside interests and hobbies. I got the impression they were less focused on the people who drive straight through college to med school to residency without looking around and having life experiences. I have a wealth of real world life experience and I could tell they respected that. Palliative medicine is about more than just practicing medicine, it about families, social and spiritual support and a holistic approach.
  14. oldpro

    oldpro MS IV

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    Yep Glad your one of the ones doing it I see you have a good grip on it.
    The Docs I worked with in the past were the same and really cared about the quality of life my patients had. It was a pleasure to work with such people I just hope to live up to it myself. (ALso to give the Nurses the respect they deserve, they do know a lot and have a perspective on the care of the Patient. );)
  15. signomi

    signomi Amongst the Gravelings

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    Absolutely. The nurses who run our two inpatient hospice beds at night (when I work) are phenomenal. They anticipate needs and offer helpful suggestions. They are the most compassionate nurses on the floor.
  16. Adcadet

    Adcadet Long way from Gate 27

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    I was a hospice volunteer during college and grad school, and that has served me incredibly well so far in med school. I'm applying to internal medicine programs now, where I'm sure I'll see lots of end-of-life stuff. I've thought about palliative care as a career, but so far it's always taken a back seat to cardiology and pulmonary/critical care. We'll see what I think in the next 1-2 years as I get more exposure to the IM subspecialties.
  17. oldpro

    oldpro MS IV

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    Yeah funny thing is when I suggest Hospice as a volunteering experience some people shoot me down as to this is not real experience and too depressing "Just death" WOW these are the posters who need to get a grip and learn what Palliative care is about! I think it is good patient and family exposure.

    Funny how OB is good and ok but Hospice is taboo!
  18. Kiralylany

    Kiralylany

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    Hi everybody! I'm a second year med student ... I've been a hospice volunteer for a little while, two diff. cities- during undergrad and now in med school. I love it! and have really pondered the idea of hospice/palliative care as the road I'd like to take. More than likely I'll go the FP route to get there. So glad to see others out there with the same interests, I don't talk about it much at my school since folks don't seem to enjoy it as a topic-- too much of a "downer" for most, but it really isn't once you take a good look at it! I too am curious what a medical director does on an average day...
    K, well back to the books....looking forward, longingly to starting third year :) ...but not the little test in between ;).
  19. Adcadet

    Adcadet Long way from Gate 27

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    Lots, perhaps most, of the palliative care docs around here are internists. I think IM is a good way to go if you want to do hospice/palliative, since most patients are adults and around here at least, there are a lot of inpatient palliative care services.
  20. Vasity

    Vasity

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    Good luck in this.

    Many people are scared, by these type of jobs. Me being a Physoclogist I am not use to this kind of treatment. Talk to you more in my nec of the woods, if you are ever around. I plan to share good information as much as possible to help everyone around , =)
  21. revlimid

    revlimid

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    Hi Signomi, I am going for a palliative care fellowship interview in few days. Could you pls tell me what kind of questions are usually asked during the interview. I have some research and publications in oncology, but nothing in particular in palliative/hospice medicine. Do you think that helps? thanx in advance.

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