Friday, March 19, 2010

Palliative Care: (Un?)-Necessary Specialty

For long-time readers of Pallimed, it would be obvious to most of you that palliative care is important enough to require dedicated specialized instruction to ensure the highest quality symptom management, skilled patient and family communication and balanced discussions of transitions in goals of medical care.

One of the web's more popular doctor bloggers, the anonymous* Dr. Lucy Hornstein (aka #1 Dinosaur - her blogging pseudonym), recently posted an entry titled: Palliative Care: An Unnecessary Specialty.

Now before you get too mad or defensive (like I first did), go read the post and the comments.  She is a family medicine doctor and the main thrust of the article (despite the provocative title) is that all doctors and especially primary care doctors should be skilled in palliative care.  A lot of the arguments come down to the frustration over too much specialization. An excerpt:

Excuse me: why do you need a brand-new "Team" to treat symptoms and talk to families?

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.
I would agree that palliative care is practiced by many good clinicians (primary and specialist) every day whether they call it 'palliative care' or not.  In fact this is one of my main teaching points to students and colleagues about the ubiquitous (and not foreign) nature of palliative care.  I applaud the many health care professionals who focus on alleviating symptoms, talk with patients and families in a way that is open and clear, and effectively understand the patient's values to help in transitioning goals from curative to palliative at the right time for the patient.

But there are a lot of patients and families who are not getting these services whether the case is simple or complex.  Thus the field of palliative care was born.

And the funny thing about this post is...#1 Dinosaur likes palliative care so much, she is thinking of becoming a hospice and palliative care doctor.

(And a quick side social media side story.
  • I saw a Tweet from Dr. Scott Lake (@doclake): This blog will make u mad "Palliative Care: An Unnecessary Specialty" http://bit.ly/cCH48U hoping someone more eloquent than I will respond
  • I replied on Twitter: RT @doclake This blog will make u mad "Palliative Care: An Unnecessary Specialty" http://bit.ly/cCH48U "I haven't read it yet & already mad" 
  • I read the blog post and using 'Share This' connected to my Gmail account was quickly able to email it to Drew Rosielle, Steve Smith (AAHPM CEO) and Eric Widera (GeriPal) (all on Twitter, but I knew they might see it faster this way)
  • Total time to now: 50 seconds
  • I commented on the blog post (5 minutes)
  • Meanwhile...Steve Smith had contacted Laura Davis (at AAHPM) who got in touch with Sean Morrison (President of the AAHPM) who wrote a great comment less than an hour after I first read about it.

Hopefully this illustration of how the networks connected to pass this information is helpful to see why we need our networks to be full, diverse, integrated and intact before we actually need them.  See you on Twitter.)
*Late edit 3/19/2010 Apparently she was once anonymous and now revealed since she wrote a book.