Monday, March 31, 2014
But this doesn't happen for free. To get here, it has taken a lot of volunteer sweat equity and time, but now as our field begins to play a larger role, more resources are needed. One critical area is our participation in the American Medical Association. If you were at the recent Annual Assembly of AAHPM and HPNA in San Diego, you likely heard a few requests to join the American Medical Association before April 1st. You may have read this excellent post by Dr. Paul Tatum on GeriPal, or past AAHPM President Dr. Ron Crossno on the AAHPM blog. Both have stellar examples of why every physician member of the AAHPM needs to sign up for the AMA. If you really don’t have time to read them, I’ll make it simple.
Our AAHPM delegate is Chad Kollas, MD, FACP, FCLM, FAAHPM and he is currently chair of the Pain and Palliative Medicine Section Council. What a great leadership role to have, and such a sad one to have to abdicate. We are also influential in the House of Delegates. See the AAHPM post for more details.
2. We are networking.
Because of our visibility in the AMA, other organizations are realizing the importance of collaboration with a group that crosses so many different specialties. And when we get involved with organizations we can help make sure their policies and advocacy efforts improve care for the seriously ill and those at the end of life. If you sign up for the AMA just this year, you are helping people you will never ever meet. You’re a pretty great person.
3. We’re on probation (and we already used our ‘get out of jail free’ card).
To cast a vote, chair committees, and essentially participate in AMA leadership we need to have 20% of AAHPM members be a part of the AMA. If we don’t meet this threshold by April 1st, then all the progress we have made in the last 5 years when we got an exception*, start to erode.
*Yes we already asked for a pass once and it was granted. Not so sure they will let that happen again.
4. I never ask someone to do something, if I have not done it myself.
Five years ago when this issue came up, I signed up for the AMA, despite having some reservations about their goals and process. You may have some of your own barriers. But we can’t fix this problem without engaging, and so I have signed up again this year. This is an investment in my own career, the career of many of my friends, and the care of the people I most want to help. And when you add that up,
it is a pretty small ask.
For just over $1 per day you can sign up for the AMA (and join the AAHPM if you have not done that either!) by April 1st, so we can show we really care about changing palliative medicine in the United States. Even better after you sign up, convince a colleague to follow through as well.
To make sure your membership is counted, please do two things - 1) make sure your primary specialty is listed as 'palliative medicine' with the AMA. You can do this by phone or on the Online Data Collection Center (AMA) and 2) complete this 20 second survey with AAHPM.
Monday, March 31, 2014 by Christian Sinclair ·
Monday, March 24, 2014
The deadline for application for the first Hospice Medical Director Certification Board is tonight, Monday, March 24th at 11:59pm CT.
Surprisingly, we have not really commented on the HMD Certification on Pallimed yet, which is unfortunate because I believe this is a really great step forward to elevating the quality of Hospice Medical Directors in the US. It has been a long time in the making after getting the initial seed funding from the American Academy of Hospice and Palliative Medicine. Having been fellowship trained in Hospice and Palliative Medicine (HPM) at a program based in a community hospice (Thanks Hospice and Palliative Care Center, Winston-Salem, NC!), I spent the majority of my fellowship in a hospice setting. Once fellowships had to be accredited by ACGME, they all had to move to University affiliated training programs, with hospice as a partner, no longer the primary. This was an important and necessary step since it helped with the legitimacy of the fellowship and integration into the rest of medical education. But the cost was the potential move to the periphery of the hospice part of the curriculum. It is possible for someone to complete a HPM fellowship with very little knowledge and experience of the administrative and clinical peculiarities of hospice if you have a fellowship that just passes the bare minimum standards of hospice experience.
So I am glad to see this pathway to emphasize the clinical and administrative responsibilities of the Hospice Medical Director, especially for the many part-time HMDs who care deeply about the quality of the care they deliver and oversee. These HMDs are unlikely to do a HPM fellowship, but still are very committed to the principles of hospice. With this certification it may spur hospice organizations increase the orientation and onboarding experience for new HMDs, so that we make sure we are not just pulling in any doctor to sit down and sign papers without any knowledge, skill, or competency in hospice.
So hopefully many more of you beat the deadline tonight to sign up for this certification if you are a practicing HMD. This first wave will be an important one; leaders who can help raise the profile of HMDs. Whether you are a part-time or full-time HMD, I hope you take this test, and get engaged with AAHPM and NHPCO, because our field needs your voice.
If you are taking the test, please share why you decide to sign up, we're curious. If you decided to not take it or wait until the next cycle, please share your reasons as well. If enough of you tell us that you are taking the test, then maybe we'll create some test questions similar to the ones we did with for the HPM Blogs to Boards Review.
Monday, March 24, 2014 by Christian Sinclair ·
Tuesday, March 18, 2014
May 15, 1920-March 1, 2014
|Dr. Primomo With Dr. Mark Prange.|
As a medical student Dr. Prange visited dying patients and their families with Dr. Primomo
Rest in Peace Dr. Primomo. I hope you know that you have paved the way for us to continue to make a difference in the lives of those who are seriously ill, their families and ourselves.
Memorial donations may be made to: UTHSCSA
Palliative care is greater than palliative care. For me my experience in Palliative care has been the icing on the cake as far as my medical practice and my life. I have found great fulfillment and I see great potential in hospice and palliative care. As palliative care physicians, nurses, social workers, chaplains and even volunteers we have gotten a peek to an aspect of living that we can explore further. Palliative care is actually service to others and in the service to others is where we find ourselves. We find our spiritual selves; we find our answers to our own questions. Palliative care in giving good symptom control, in fostering good communication, in good ethical practice and in looking out for the spiritual side of life; can assist us in overcoming the fear of death. And in making death a safe, fulfilling and enriching experience not only for the dying patient and their family but also for the physicians and nurses caring for the patients.
|Dr. Primomo in 2007 presenting on spirituality|
Dr. Malakoff on the left was the first palliative fellow at UTHSCSA
Dr. Sandra Sanchez-Reilly on the right is the UTHSCSA and VA Palliative Care Fellowship Director
- Mary M. Heidbrink, Dr. Primomo pioneered hospice care here San Antonio Express-News : March 8, 2014 accessed March 8,2014 at http://www.mysanantonio.com/obituaries/article/Dr-Primomo-pioneered-hospice-care-here-5298564.php
- Marion Primomo MD February 2008 Grand Rounds: The history of palliative care. Accessed March 8, 2014 at http://youtu.be/ZzLP_XKjJpc
- Marion Primomo MD March 2007 Grand Rounds: Spiritual/Existentialism Needs at End of Life http://youtu.be/rHsz_rXBYTA
- Kelly A. Goff. Women Physicians. San Antonio Women magazine May/June 2004 Accessed March 8 2014 at http://www.sawoman.com/women-physicians
- Porter Loring obituary Marion Primomo MD. Accessed March 8, 2014 at http://www.porterloring.com/sitemaker/sites/Porter1/obit.cgi?user=1260662PrimomoMD
- Dr. Marion Primomo was given the "Outstanding American by Choice" recognition by the US citizen and immigration service (USCIS) in San Antonio Jun. 22, 2006 http://www.uscis.gov/archive/archive-citizenship/archived-outstanding-americans-choice/2006-outstanding-american-choice-event-photos
- Memorial donations may be made to: http://makelivesbetter.uthscsa.edu/primomo
- Photos courtesy of Mark Johnson
- Dr. Primomo’s must read suggestions:Man's Search for Meaning
I and Thou by Martin Buber
Tuesday, March 18, 2014 by Jeanette Ross ·
Wednesday, March 12, 2014
Hopefully many of you are arriving (or have already arrived in San Diego) for the AAHPM/HPNA Annual Assembly. I love this conference and this is my 11th year in a row, that I have been lucky enough to attend. There is great knowledge and wonderful camaraderie here, and I want to make sure that no matter where you are, you can take advantage of all this week has to offer.
If you are at the conference, please consider using Twitter as a way to spread information. Every year participation has grown and diversified way beyond the walls of the conference halls. We've talked a lot about the benefits of Twitter at a Medical Conference before. Your participation really makes this a success. There is a large community of advocates who look for good material from HPM professionals to pass on. So sign in and ask for your password if you forgot it, and began re-tweeting, and engaging. The hashtag to use this year is #hpm14. You can see the latest tweets using the hashtag even with out a Twitter account.
Some good resources for Twitter:
Also don't forget to check out the AAHPM blog, AAHPM Facebook Page, HPNA Facebook Page, and Pallimed Facebook Page for updates throughout the week. Of course, liking, sharing and engaging on these platforms help spread the good information that we all care about.
And don't forget the Pallimed / GeriPal Party on Thursday night. Let us know if you are coming, and follow #hpmparty on Twitter for more up to date details that evening.
Look forward to seeing you there!
Wednesday, March 12, 2014 by Christian Sinclair ·
Monday, March 10, 2014
The annual Pallimed / Geripal party is back on for this year's AAHPM/HPNA/SWHPN 2014 Annual Assembly. We are going to do a similar progressive party as we did at the 2013 annual meeting in New Orleans. What does this mean? Basically we will start off at the Field Irish Pub at 9pm on Thursday March 13, and as the evening progresses, we will be moving to different locations. The only way to find out where we are is to use social media and follow on of the Pallimed/Pallimed feeds, or the #HPMparty hashtag.
Date: Thursday, March 13th. Start time 9pm. End time TBD
Starting location: The Field Irish Pub
Monday, March 10, 2014 by Christian Sinclair ·
Wednesday, March 5, 2014
I read it in 2004 when I was a hospice and palliative care fellow and I was so hungry for any knowledge about how to be a better doctor for people at the end of life. It may be hard to believe, but in 2004 there wasn't a lot of readily available information like we have seen in the past few years. The lessons from the book still resonated, even though the book was a decade old at the time I read it.
As a surgeon he recognized that he had been fighting against death and instead over-medicalizing this universal human event throughout his career and was willing to say it publicly and call out the medical establishment for doing the same. The New York Times obituary points out that Nuland himself worked hard to give his brother hope for cure and survival before his death in 1990, which is a familiar story to anyone who has ever cared for a patient with health care professionals in the family.
The book rising to national prominence came when the country was grappling with issues of medical care and control over the end of life. If you know your end-of-life ethics history you will obviously recognize the year 1994 for its significance in ushering the United States first voter approved initiative for physician aid-in-dying with Oregon’s Death With Dignity act. (It was challenged in the courts and did not become implemented until 1997.) It was also not long after the Patient Self-Determination Act (1990) highlighted the need for advance care planning, and other important ethics cases such as Dr. Jack Kevorkian and Terry Schiavo.
His writing diversified but he always foucsed on combining his career of medicine with a little philosophy including books such as The Art of Aging, How We Live, and The Soul of Medicine, in addition to numerous articles in non-medical publications. You can watch him at a very early TED talk from 2003 on the Extraordinary Power of Ordinary Humans. Or watch him talking about his inspiration for "How We Die" and how 'Death was in the legend and lore of my family.'
One passage that stood out to me in my early career is his description of The Riddle. I saw this in myself as a medical resident looking backwards and have seen it since practicing as a palliative medicine doctor.
“Every medical specialist must admit that he has at times convinced patients to undergo diagnostic or therapeutic measures at a point in illness so far beyond reason that The Riddle might better have remained unsolved. Too often near the end, were the doctor able to see deeply within himself, he might recognize that his decisions and advice are motivated by his inability to give up The Riddle and admit defeat as long as there is any chance of solving it. Though he be kind and considerate of the patient he treats, he allows himself to push his kindness aside because the seduction of The Riddle is so strong and the failure to solve it renders him so weak.”If you decide to pick his book up and give it a fresh look now that it is 20 years old, let me know what you think of it. Maybe we could have a historical book club?
Wednesday, March 5, 2014 by Christian Sinclair ·
Sunday, March 2, 2014
Sunday, March 2, 2014 by Christian Sinclair ·