palliative care

[daisygirl]

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Hi everyone out there,
I was wondering what you guys thought about palliative care and its state in this country. The reasoning behind this question stems from the assisted suicide debate. I feel that "one" of the reasons that assisted suicide has come to the forefront is because of the underutilization of palliative care due to many reasons, one being that insurance companies do not pay enough to help families where this option is desperately needed. My real question though is how does the medical communtiy view palliative care? Do medical schools devote time to this topic, or is it "ignored" because it conflicts with the physicians primary goal of healing/preserving life? I know that palliative medicine is a "newly emerging" field of medicine, but I would like any opinions on how the general medical community views palliative care. Thanks for any input. 😀 😀

 

[Tweetie_bird]

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!

Tweetie

 

[Tweetie_bird]

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

 

[daisygirl]

Hi Tweetie_bird,
In your research did you find that the insurance companies will pay out lots of money on treatments that prolong the suffering of the terminally ill? I feel that what I just mentioned is true (though I ask you because I am not an expert). Why do you think that this is so (if so). I just do not understand the logic behind choosing medical care that prolongs suffering versus the option to provide dignified care to a patient where there is no alternative (palliative care). 😕 <img src="confused.gif" border="0">

 

[Tweetie_bird]

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.

Tweetie

 

[Tweetie_bird]

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

 

[polarbear]

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......

 

[Tweetie_bird]

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.

Tweetie

 

[italianlove]

Originally posted by polarbear:
•

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......•••

Very well said polarbear!

 

[jdub]

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.

 

[EpiII]

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.

 

[Tweetie_bird]

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.

 

[daisygirl]

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. ••

Epi,
I do agree that there are issues that are inherent in PAS and these issues are not related to inadequate access to palliative care. I find it hard to understand why you feel that PAS should be discussed without looking at the palliative care angle. PAS has become popular with many people and I feel that this popularity may be "due in part"(the following is not meant to be a blanket statement as to the cause of PAS) to the feeling that the terminally ill do not have many options-palliative care as an option does not always come to one's mind. I feel that the medical establishment, as well as the insurance companies, have not completely embraced palliative care's objectives and usefulness. This lack of advocacy on the part of the medical community may be one of the reasons why the general public is not fully informed with respect to the medical options that are available for the terminally ill. PAS is not driven simply by the underutilization of palliative care, but PAS can be symptomatic of the people's attitude of how they view the medical establishment's treatment of the terminally ill. I am curious as to what your feelings on this is and why.

 

[daisygirl]

jdub and tweetie,
Thanks for the book recommendations, I have added the books to my post-Christmas shopping list 😀 😀

 

[k's mom]

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.

 

[daisygirl]

"cure at times, alleviate frequentally, but always comfort" ••
Dear K'mom,
I feel that the quote above, which jdub used in his post, eloquently states what a physician's
objective should be. I am in agreement with you, something needs to be done to improve how medicine is delivered to patients who are terminally ill. You are absolutely right in stating that your grandmother could teach the medical community about death and dying, hopefully the medical community will realize that there is a need for improving the way palliative medicine is taught and how it is administered.

 

[Tweetie_bird]

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.

Tweets

 

[EpiII]

Originally posted by daisygirl:
•
I find it hard to understand why you feel that PAS should be discussed without looking at the palliative care angle.•••

I did not mean to imply that the two are not in some ways related, I simply was saying it would be better to have two threads, one discussing the pros and cons of PAS and one discussing Palliative Care. It seems this thread has taken up the later approach. Sorry for the misunderstanding.