Our favorite Dinosaur starts her rant by praising me and then (using a wonderful debating technique) totally disagrees with me – Palliative Care: An Unnecessary Specialty
True palliative care — the management of symptoms — is part and parcel of everyday medicine. Itching; nausea; constipation; pain. Work them up to make sure there is no serious underlying problem, of course, but for crying out loud, don't tell me you now need another specialist to actually come TREAT them! This is fragmentation of care taken to outrageous extremes.
As for talking to patients and families about difficult decisions when curative treatment is no longer an option, that too is part and parcel of my job. I do it every day in my office, and the only reason I don't come to the hospital to do it is because I can't get paid for it, and I can't afford to work for free.
So I must disagree partly with the Dinosaur. While I agree that excellent primary care physicians and hospitalists can and should provide the same care that palliative care physicians provide, I still find palliative care very valuable.
What makes our palliative care physicians special?
First, they can take the necessary time to talk to the patient. I am talking about at least an hour for an initial evaluation. Our hospitals help support them to perform this function.
Second, they have ongoing relationships with all the relevant agencies, giving them the ability to pull things together much more seamlessly than I can. They have the team, and the team has great value.
Third, we have an inpatient service that caters to palliative care patients. The palliative care docs have worked with the nursing staff to encourage them to be comfortable with all the details of palliation.
Finally, they provide the home services that I could provide, but that I find difficult to provide.
Is this a specialty? I consider that a moot question. I would rather focus on the value that our palliative care physicians provide to our patients.
Primary care physicians can do this, but probably not quite as well due to the time commitment involved. I have done much palliative care during my career, but sometimes having that specialist involved does make a difference.
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Thanks for the support and feedback. Actually once I was teaching a medical student about the specialty, and she asked, “Isn’t that what all doctors are supposed to do”
I said, “Yes they are supposed to, and they would often like to, but the system squeezes these parts (symptom control, goals of care, and patient/ family centered communication) out.”
If our system compensated physicians properly, we would not need palliative care physicians. Some argure we wouldn’t need hospitalists if doctors could bill based on time (like lawyers do).
But until that happens only subsidized physicians can afford to do real palliative care – it takes time to do it properly and the workload is too high to let us spend time with our patients.
Well PCP can do flex sig, skin biopsies, joint injections etc etc, so why are are there all these referrals to specialists. I have family members who went into Hospice and I appreciate that there was a team that knew how to talk about this.After 90 min of discussion and my aunt was very appreciative because she knew her oncologist, hospitalist could not have given this kind of info or time for her. Many a times we see patients who should not even be admitted given the extent of their disease and we see their Primary care never took time to sit down with patient and family regarding prognosis, options etc. I am appalled that there are people who dispute the value of palliative care . It will be become a JAHCO req soon for all hospitals. This one speciality that can help control costs and help families cope with that decision.
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