Stigma Against "Palliative Care"?

[WayChanger]

To my shame as an English major, I was a little less than completely careful with my diction on my personal statement (already submitted and processed, so too late to do anything about it), and I stated somewhere that I wished to provide "palliative care." I only took a closer look today after my mom (a healthcare professional) read my statement and thought the term was rather negative. I guess when I wrote it, I was thinking more of the holistic connotations of the word "palliative," as well as the emphasis on pain and symptom reduction. Perhaps "holistic" or "restorative" might have been better... I was somewhat unaware of the huge "palliative care" movement out there...I kinda just chose the word. In any case, I didn't think it was that bad, since palliative care is a necessary part of medicine anyways, but I was wondering if anyone felt there was a stigma attached to the term. I know that palliative care was once thought as mutually exclusive with more "active care," but that seems to be no longer the case. Apparently, the definition of "palliative care" is changing to encompass a broad range of health services for terminally ill patients and their families, rather than focusing exclusively on end-of-life. In the context of my essay, the term appears as just one of the services I hope to provide, not the major service by any means. Does anyone think I might get in trouble for seeming to advocate "palliative care" rather than expressing complete interest in cure-based active care?

Cheers

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[Bobblehead]

Palliation has a broad range from fairly aggressive therapies such as chemo/radiation, etc. with respect to cancer to the more tranditionally regarded hospice/comfort measures definition. Only certain types of cancer at certain stages can be cured although some oncologists may disagree with that view and there's always the exceptional patient that makes it through to CR somehow. Palliation isn't all that bad of a term to use and its concept is underutilized. But that's just my personal bias.

You'll likely be asked to explain your choice of words. I suggest you familiarize yourself with the many difficulties in end of life care of the chronically ill patient so you can hold an intelligent conversation.

 

[zhaf86]

somehow i don't think you'll get in trouble actually. perhaps what you could do is actually see what goes on in a palliative care environment (eg: hospice). volunteer there - it forces you to face up to a multitude of issues such as

i) the limitations of modern medicine (medication in palliative care CANNOT cure their maladies, in fact it is the same for most of modern medicine)
ii) would you rather be a pragmatic or idealistic doc? many in palliative care are as close as they can be to kicking the bucket, is it worth the strain on limited resources to ease their pain?
iii) emotional frailty and strength - both your own and your patients'. you get to witness death (sometimes painful) in direct and indirect ways, that was challenging for me. but it helped that the docs and nurses were very strong people who helped me through the experience.

 

[powermd]

Another way of defining 'palliative care' and how it differs from ordinary medical care is in it's goals. The goal of medical care is to cure the disease, whether or not that's realistically possible. The goal of palliative care not to cure, but to minimize the impact of disease on a person so that they may be comfortable in the time they have left.

I would avoid using the word 'holistic' with medical school interviewers. Non-MDs often describe what they do as 'holistic' to distinguish medical practices that border on (or are) quackery from evidence-based medical care in an attempt to mislead the public into thinking MDs do not offer medical care that 'takes into account the whole person, and not just the disease.' Every medical school teaches students to consider the context of a person's life when helping them make health care decisions. To say that you wish to practice 'holistic' care kind of implies that other doctors do not. I would avoid that word and just say what you mean in plain language. Med school interviewers are not as sophisticated as you are with the English language.

To my shame as an English major, I was a little less than completely careful with my diction on my personal statement (already submitted and processed, so too late to do anything about it), and I stated somewhere that I wished to provide "palliative care." I only took a closer look today after my mom (a healthcare professional) read my statement and thought the term was rather negative. I guess when I wrote it, I was thinking more of the holistic connotations of the word "palliative," as well as the emphasis on pain and symptom reduction. Perhaps "holistic" or "restorative" might have been better... I was somewhat unaware of the huge "palliative care" movement out there...I kinda just chose the word. In any case, I didn't think it was that bad, since palliative care is a necessary part of medicine anyways, but I was wondering if anyone felt there was a stigma attached to the term. I know that palliative care was once thought as mutually exclusive with more "active care," but that seems to be no longer the case. Apparently, the definition of "palliative care" is changing to encompass a broad range of health services for terminally ill patients and their families, rather than focusing exclusively on end-of-life. In the context of my essay, the term appears as just one of the services I hope to provide, not the major service by any means. Does anyone think I might get in trouble for seeming to advocate "palliative care" rather than expressing complete interest in cure-based active care?

Cheers

 

[diamondice79]

To my shame as an English major, I was a little less than completely careful with my diction on my personal statement (already submitted and processed, so too late to do anything about it), and I stated somewhere that I wished to provide "palliative care." I only took a closer look today after my mom (a healthcare professional) read my statement and thought the term was rather negative. I guess when I wrote it, I was thinking more of the holistic connotations of the word "palliative," as well as the emphasis on pain and symptom reduction. Perhaps "holistic" or "restorative" might have been better... I was somewhat unaware of the huge "palliative care" movement out there...I kinda just chose the word. In any case, I didn't think it was that bad, since palliative care is a necessary part of medicine anyways, but I was wondering if anyone felt there was a stigma attached to the term. I know that palliative care was once thought as mutually exclusive with more "active care," but that seems to be no longer the case. Apparently, the definition of "palliative care" is changing to encompass a broad range of health services for terminally ill patients and their families, rather than focusing exclusively on end-of-life. In the context of my essay, the term appears as just one of the services I hope to provide, not the major service by any means. Does anyone think I might get in trouble for seeming to advocate "palliative care" rather than expressing complete interest in cure-based active care?

Cheers

just be ready to explain it in your interviews... 😉

 

[LizzyM]

I would interprete "palliative care" as meaning that you are interested in end of life care. I would perceive that as a noble goal, not something to look down upon. Be prepared for interviewers who are going to make that interpretation. Be prepared, too, for questions on euthanasia and physician assisted suicide and removal of life-support.

Sometimes, the rare applicant who is an English major interested in palliative care is a refreshing change from the biology and chemistry majors who are fascinated with the human body and who are sure they will be able to cure everyone once they have M.D. after their names.

 

[AJM]

It's interesting that your mom thought that palliative care had a lot of negative connotations -- it actually isn't considered to be a negative, and it's the standard term in the medical community when describing end-of-life care and symptom management.

Palliative care is it's own specialty with full-fledged palliative care fellowship programs that one can do after an internal medicine residency. These programs train physicians not only to provide excellent hospice care, but also to treat difficult-to-control symptoms among patients with chronic diseases, such as chronic pain, pruritis (severe itching), and chemo-related nausea.

If I were reading your application, I would have interpreted your statement as meaning that you wanted to pursue the specialty of palliative care. This may come up on interviews, especially since it's not that common for a pre-med to express an interest in palliative care, so you should be prepared to discuss what you actually meant.

Don't worry about any negative connotations, though -- it's a respected and growing medical specialty.

 

[Hebrew Hammer]

Among health care professionals, palliative care does not have a stigma attached to it. palliative care is gettin integrated into curative medicine at earlier stages in patient care than it ever has before. I work with ovarian cancer patients at the MGH who have an extremely low chance of long-term survival. Palliative care is getting introducedduring the begining stages of their treatment and not just at the end of their lives when they are admitted to Hospice. Depending on how you treated your description of palliative care, the adcoms might be truly impressed with this. Palliative care only has a stigma relative to patients understanding of the what the word means in their care. Patients often assume that it means that nothing more can be done, and that the providers are giving up. Adcoms (hopefully health care professionals themselves) will not share this stigma... good luck!!!!

 

[WayChanger]

Thanks for the responses, everyone! Really appreciate it.

Cheers!

 

[gerido]

To my shame as an English major, I was a little less than completely careful with my diction on my personal statement (already submitted and processed, so too late to do anything about it), and I stated somewhere that I wished to provide "palliative care." I only took a closer look today after my mom (a healthcare professional) read my statement and thought the term was rather negative. I guess when I wrote it, I was thinking more of the holistic connotations of the word "palliative," as well as the emphasis on pain and symptom reduction. Perhaps "holistic" or "restorative" might have been better... I was somewhat unaware of the huge "palliative care" movement out there...I kinda just chose the word. In any case, I didn't think it was that bad, since palliative care is a necessary part of medicine anyways, but I was wondering if anyone felt there was a stigma attached to the term. I know that palliative care was once thought as mutually exclusive with more "active care," but that seems to be no longer the case. Apparently, the definition of "palliative care" is changing to encompass a broad range of health services for terminally ill patients and their families, rather than focusing exclusively on end-of-life. In the context of my essay, the term appears as just one of the services I hope to provide, not the major service by any means. Does anyone think I might get in trouble for seeming to advocate "palliative care" rather than expressing complete interest in cure-based active care?

Cheers

I plan to be involved in palliative care and openly discussed it with adcoms member. It wasn't a problem, and I personally don't see a stigma attached to it. Since you wrote about it, and apparently not very well informed about it, i'd suggest you become familiar with it and be ready to discuss the pros and cons and why you think it is necessary.

 

[TheMightyAngus]

What was the context of your use of palliative care? I think the first thing that comes to mind when you mention "palliative care" is physician assisted suicide and end-of-life care. I'm not sure by your definition. Inherently, all forms of therapy are active and designed to alleviate pain and/or reduce symptoms in some way. If you used this word by mistake, be sure you can talk about true palliative care anyway. It will look bad if your interviewer gets the impression you don't know what the term means.

 

[WayChanger]

It was a sort of by-the-way sorta thing...I mentioned it when I was concluding a paragraph about my teaching/tutoring experiences. I talk a bit about the social aspects of medicine, and conclude with "As a physician, I hope to continually enlarge my personal paradigm, learning about the people I serve and the world around me while doing to my best to provide palliative care."

Since it's on a tone of conclusion, and it's near the end of my statement, I think most likely it will give the impression that I am articulating an intent to specialize in palliative care. I think my strategy for interviews, if the issue comes up, will be simply to explain that I meant it in a broad-based context, in symbiosis with curative care, which I do discuss at length elsewhere in my personal statement.

I think everyone is definitely correct in that I will need to be knowledgeable about this topic, however. I'm not too worried, since I actually am very interested in end-of-life care and the treatment of chronic illness. I didn't intend to articulate it as such in my statement, but it won't be a big stretch for me to talk about it.

Cheers