Feeling Millennial - Our 1000th Post

This is our 1000th post!  Christian posted an absolutely fantastic 5 year anniversary post, including a summary and history of Pallimed, back on June 7th:  highly recommended, and I'm not going to recapitulate his summary here.   I still have a hard time believing this thing I began noodling around with as a graduating internal medicine resident in 2005 has become what Pallimed is today.  I have my collaborators to thank for that, particularly Christian, who is absolutely responsible for keeping our blog alive, and evolving, and expanding.  Thank you my friend.

I've been toying around with an idea for a lighter post the last few months, particularly with the new fresh fellow season which is upon us, and thought our 1000th post was a good opportunity to do this.  I've been thinking about this lately with the new fellows, because I've been finding myself saying these things over and over, as I do every year, as I talk with trainees about this wonderful thing we do called palliative care.

So here they are - pearls for successful palliative care consultation (in no particular order).  I make no claims that any of these are original to me even if I've lost track of where they came from.  Feel free to claim them for yourself in the comments.  Few of these, particularly the ones I came up with, are aphoristic - if any of you can aphorize them please do so, in the comments.  If we get some good additions we may try to find a more permanent home to our collected wisdom.

1. Assume nothing, ever. 
2. Always talk to the team first.
3. Respond to emotion with emotion. 
4. 75% of what we do is showing up and shutting up.  
5. Tame the beast inside who just wants to talk, talk, talk.
6. Don't just do something, stand there.
7. Acute symptoms = acute meds.  (That is - don't jack around with long-acting/continuous meds for out of control symptoms without first actually making someone comfortable with bolus/immediate-acting meds.)  This is a variation of the idea behind:
8. NO DRIPS 'TITRATED FOR COMFORT.'
9. 'Good work' describes a process, not an outcome.
10. Palliative care is just good medicine.
11. And what is their bowel regimen?
12. What is their narrative?
13. Just because someone has less than 6 months to live doesn't mean hospice is right for them. 
14. You should worry more about your patients who want to die, and less about those who are desperate to live.
15. It's not about you.  (This is in reference to patients' and families' emotions.)

My absolute all time favorite, which was told to me I think by David Weissman, who was quoting a former oncology fellow of his:

    16.  You can't shine shit.

Please add your own. 

Thanks for reading, thanks for sharing Pallimed with your friends and colleagues, and thanks for commenting.

(Image from here, via Google image search.  Could not identify any copyright information.)