palliative care

Yeap, completely agree...those money greedy insurance companies don't seem to support pallative care (not as much). It's ironic that you bring it up....I am writing a paper (hopefully to be published) on that topic, and assisted suicide.
Not to open a whole can of worms, but I do think that PAS should be legalized, and I am glad Oregon realized it soon enough. I won't go into details here, but personally I think the need for palliative care is much different from the need for PAS. If you look at the statistics, over 75% (off the top of my head) of the docs say they would practise it if it is leglized..over 50% said it should be. Anyway, I am rambling.

How do we fix this problem--perhaps have some more dollars go into programs that specialize only on hospice care; free counseling/support groups run "for the people, by the people"....where will the money come from? I wish I knew!

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sorry, forgot to mention, PAS = Physician Assisted Suicide.

 

Hi Daisy,
You pose very thought provoking questions--and the answers are on many different levels. Part of the problem lies in the fact that differen fields in medicine (holistic care, acupuncture etc) are not usually insured heavily. I have actually heard of people who go to an MD to get diagnosed, and then go to a DO to get the therapy, and have to pay for that out of their pocket. Unfortunately, palliative care doesn't work that way. I haven't researched into insurance companies supporting pall. care that much, as I looked into issues around euthanasia. But your intuition is right, and the system needs to be fixed. There are far too many people suffering terminal diseases in excrutiating pain, waiting for another experimental drug to come out that can help them. Here's what the AMA thinks on this issue-if there is even the slightest glimmer of hope that a patient's health could get better, therapy should not be stopped. In fact, the only time any therapy can be removed, is when there is irrefutable evidence that no amount of therapy would not prolong the life or health of the patient substantially. Until then, the patient keep going through any and every therapy, unless they choose to refuse tx. (which is a whole other issue)....whew!
So...if we put more money into palliative care, we would have to take it out of somewhere....but where?? That is the dilema. Hence,we see no change in the system yet.

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damn my spellings need to be checked!! but I am too lazy to fix em

 

Daisygirl,

Thanks for starting this interesting (and VERY important, IMO) thread.

But I must say that I disagree with the notion that palliative care "conflicts with the physicians primary goal of healing/preserving life." Although I would agree that healing/preserving life is certainly a primary goal of the profession, the alleviation of suffering is also an equally important pursuit of medicine. With that in mind, I really don't think that palliative care undermines any of the values that medicine stands for. In its constant pursuit to "heal and preserve life" we sometimes forget that there comes a point where medicine simply reaches its limits, and death becomes an inevitability. In these cases, palliative care, and it's goal of alleviating suffering and allowing people to pass away as comfortably as possible, can be an incredibly life-affirming thing.

Just some thoughts......

 

Polarbear,
You are right...palliative care is certainly the epitome of medicine depicting compassion, humaity, and encompasses more of "healing and preserving" than almost any specialty in medicine. It is important to realize that as a termnal disease progresses, the role of the doctor slowly shifts from curing the disease to alleviating the pain and suffering of the patient. Unforunately, we tend to forget that such people need to be comforted in every way, which is what palliative care provides. However, with the big bucks going into life prolonging therapies, nobody really thinks to invest in palliative care, to ensure a good quality of (prolonged) life of the person. That is what Daisy (and myself) are trying to imply.

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btw, a book called "dying well" by ira byock is wonderful and talks about hospice and palliative care.

there have actually been quite a few books written about death and dying in a hospital setting and of course the pioneer of that was kubler-ross. i still believe that open discussion of death and stuff like palliative care is lacking to say the least.

since we are all going to die one day and many of us will die in a hospital, one would think that medical schools would try and educate their graduates on the subject, but i believe most schools still put aside relatively few hours to cover the subject in detail.

i still don't know who osler was, but he has a quote which i am sure is famous cause it was translated to spanish in this palliative care book that i bought, anyhow . . . it goes something like "cure at times, alleviate frequentally, but always comfort". i think that that pretty much sums up medicine.

 

Osler was Sir William Osler. He was born July 12th, 1849 and died December 29th, 1919.

He was one the leading physicians in the world when he died and wrote many influencial things that are still being referenced and taught today. I can almost guarantee that all of us will here of him when we get into Med School.

Good topic of discussion, but I think we should discuss palliative care separately from physician assisted suicide. While on the surface there are similarities, there are real differences beneath the surface.

 

One book I liked--"The Good Death: The need to reshape the End of life" (or something like that) written by Marilyn Webb. She has TONS of info in there about different issues ...stats...personal accounts. An easy reading too.

 

To help put a face on this very interesting conversation, my grandmother has been dying of cancer for the past 11 months. She is relatively young (62) and decided not to seek treatment (She survived ovarian cancer 30 years ago and spent five years nursing her own mother through a mastectomy and chemotherapy...she is ready to die.) The problem has been that the doctors simply could not give her any idea of what she would experience. They only knew what to expect as an outcome of their prescribed therapies. She wanted to talk rationally about the course of her death, and they just were not prepared to do it. Believe it or not, her primary problem has not been pain, but hormonal discomfort. In her words, "If I'd known I had to deal with hot-flashes, I wouldn't have signed up for this" (She has a wonderful sense of humor). Unfortunately, the doctors had no training to help her through, and simply had to rely on throwing medication at her and hoping something worked. Thankfully the hospice nurses and volunteers have been there to help her through. I truly hope that mainstream medical education is beginning to deal with the true nature of end of life issues.

Right now grandma is pissed off because her oncologist gave her 3 months to live ten months ago; starting January 1st she has to fulfill her insurance deductible again. I guess if the schools can't teach doctors about death and dying, my grandmother sure can.

 

I think it will take long before these people realize how to implement these issues in medical school training. Let's face it, if these people are not giving Psychology/Physiologial Psychology it's due in Medicine, how long do you think it will take before they catch up with issues surrounding palliative care?
I think that for now, physicians themselves will have to realize and think about these issues themselves, till the education depts catch up with it. Hence, the importance of talking about it before we even enter the field.

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