Palliative care, hospitalists and outpatient physicians


Category : Medical Rants

This week I will likely write some very personal entries. We admitted my 87-year-old father to the hospital last night.  He has what many physicians call the "dwindles".  At this time he needs help with most all activities.  My mother performed these tasks for too long, and she is very tired.  I made the decision to get him admitted last night.

First I talked with his excellent internist.  My parents love these internist, and I have found him bright and concerned in our several phone conversations.

I had originally suggested palliative care, but I actually believe that he did not have previous experience with palliative care, and he quickly offered hospice care.  Now I am not the best physician at clarifying the differences between a palliative care approach and a hospice approach, but palliative care was really the key for my dad.

Last night I talked with a wonderful hospitalist.  She was most informative about his condition.  She suggested a palliative care consultation and I was delighted.  I will be flying to visit him tomorrow and hope to meet with the palliative care team then.

As I pondered my experiences trying to help my parents through this difficult time, I may have had a revelation.  I really need some experts to help here.  Palliative care has started primarily to meet inpatient needs.  Palliative care does provide excellent outpatient assistance, but I believe it generally starts from an inpatient evaluation.  Palliative care could move into the outpatient arena, but they appropriately receive some pay from hospitals.

I suspect that pure outpatient physicians have much less exposure to palliative care.  That may explain my disagreement with our favorite Dinosaur recently – Is palliative care a specialty?

As one who focuses his clinical time in the hospital, I am relieved and delighted that my father is in a hospital that has an excellent palliative care service.

Comments (9)

How about a physiatry/rehab consult? Does your father have a terminal disease or does he need inpatient therapy?

I do wish that my area had more outpatient palliative care options. I had a patient that died recently in his 90s. He was living with his wife, and his main problem was a chronic GI bleed. He had some slowly bleeding AVM’s in his small bowel that were inoperable.

He lasted about a 14 months, getting transfusions every 1-3 months. He wasn’t a clear hospice candidate because his life expectancy was unclear, and he still wanted transfusions. But our goals were still symptom management, not cure.

so you need to admit him in order to get palliative consult? wondering… can that be coordinated as out patient when time comes?

Not a professional – but…

Have you considered adding home nursing. Mom hired LPN’s. Dad (retired GP) was comfortable having them care for him. Dad wanted to stay at home. Mom wanted him to stay at home as well but needed the help. It was the best solution and eventually evolved to 24/7 care.

My hospital started a palliative care service (NP driven, MD oversight). It’s one of the best things to hit Happy’s hospital for my patients AND for me in seven years.

It is so hard to watch a parent getting to the point of needing care. All those in the healthcare field deal with it almost daily, however it always catches you off guard when it happens to you.

Best wishes to your family in this trying time. Glad you get to spend some time together.

It sounds like your family is going through a pretty hard time. I wish all the best to you.

I had surgery on 15th December 2009 on my right knee. Went in for a cartilage repair/meniscure. Two weeks later the bandage and dressing was removed on a check up by the orthopaedic surgeon. I had to wear a brace for 8 weeks. I landed up going to the trauma unit on 14th February, 2010 as my whole leg swelled up like an elephant.
I know have dvt x 2 clots in my leg. On warfarin, walking like a paraplegic, cannot walk normally. Recently I went for a second opinion to another surgeon who discovered that I have a lot of swelling behind my knee after he did an mri scan. He asked me why i am not wearing ted socks. I was shocked, as he said it is standard procedure to have them put on once the bandage was removed. This he said would have avoided the dvt. Is there anyone out there who has had a similar experience. Eric

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