Monday, January 24, 2022

The Annual Assembly and COVID

by Christian Sinclair (@ctsinclair)

Last week, many hospice and palliative care clinicians and advocates received the unfortunate news that the 2022 Annual Assembly of Hospice and Palliative Care (#hapc22) was moving from hybrid (both in person and virtual) to virtual only. The board of directors of AAHPM and HPNA "considered the current strain on health care systems, personnel and their families" when making the decision. And then one week later, many presenters found out their presentations were not going to be in the virtual-only assembly. That is immensely disappointing. I received notice that my talks - on which colleagues and I had spent hours working - were canceled too. I was shocked at first, then mad, a little incredulous, then sad I would not get to share my work with a wider audience. Online, others shared similar emotions about the bad news. It really stinks.

I think it is critical to direct the majority of ire at COVID, which threw us all a curve ball with omicron. Honestly going into October and November, many clinicians I know were beginning to regain that hope and return to normal. The clinic visits were more often in-person (rather than telehealth). We had meetings with small groups in big rooms. All signs pointed to "Yes!" An in-person Annual Assembly in Feb 2022 seemed possible. So when you feel angry, make sure to direct that anger at COVID..

As for mitigation of risk, or different strategies, or communication planning around this issue, it is reasonable to ask for more information from the two organizations, but let's make sure we are asking the right questions and the right people. The strategy is the responsibility of the board of an organization. The staff of an organization is responsible for executing on the plan set out by the board. Boards need to make very difficult decisions. From personal experience, those conversations before the decision can also be quite challenging. I think the business meetings for both HPNA and AAHPM should be high on your priority list if you want to hear more about how we got here. If you want more information or have issues with how things were handled, reach out to board members to tell them what is important to you.

One thing to keep in mind is that leadership is likely feeling some of the same emotions we are feeling. I know this from personally working with the AAHPM and HPNA staff. They put a lot of time and effort into making the 2022 Annual Assembly happen, and now a lot of that work is lost. So when reaching out to them for clarification or giving feedback, make sure to appreciate the ripple effects of COVID and that many of these decisions are often more difficult than they appear on the surface.

And if you still don't like how leaders are making decisions, then consider running for a volunteer position. Influence in a way that you think is best. There are always volunteer roles to fill. And it offers a perspective that things are often more difficult than they appear on the surface.

And lastly,I'm sorry that your work and the work of your colleagues and mentees won't get the attention of a national meeting. And yet, the good work is done. It just needs a little extra effort to find a home. Like one of my favorite quotes from Austin Kleon, "Do good work, and put it where people can see it." Already online, there are venues like HAPC Virtual Didactics, Friday Chalk Talk, GeriPal, and even Pallimed, making themselves available to repurpose or rework content. Honestly, this is something I would love to see our field do more of. Don't stop at "Well, I presented at the Annual Assembly. My work is done here." Call up colleagues at other institutions and let them know you have an excellent presentation for their next grand rounds. Do a media tour for the field: pitch your content to your local news media or write an editorial for national outlets like NYT, WaPo, The Atlantic, etc. Write a paper and publish it in an academic journal. Some of this you can do all on your own, some of it may require activating your mentor and peer network. So yes, feel your feelings, and then get to work finding a home for your great work. All is not lost.



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Christian Sinclair, MD, FAAHPM is a palliative care physician at the University of Kansas Health System, editor-in-chief of Pallimed,and trying to keep up a resolution to write more about palliative care in 2022.

Monday, January 24, 2022 by Christian Sinclair ·

Monday, January 17, 2022

Difficult Conversations About Racism

by Christian Sinclair (@ctsinclair)

There are many difficult situations we encounter in palliative care and hospice. Our training and experience equip us with words and skills to explore emotion-inducing topics. Yet there are still moments many clinicians can be caught speechless, and one of those is when we encounter racist language in the midst of our work.

If I had to pick the most influential article in 2021, it would be "Power, Silence, and Debriefing: Hidden Harms When Palliative Teams Encounter Racism" by Rev. Florence Moss and Dr. Kate McKillip, published in the Journal of Pain and Symptom Management in June 2021. I have shared it numerous times with colleagues and trainees, so much so, "Moss McKillip" regularly autofills on my search engine.

I was reminded of the power of this article with Rev Moss and Dr. McKillip presented for Friday Chalk Talk* led by Dr. Martin Bazelak this past week. If you are looking for speakers for your next Grand Rounds, I would put these two on your 2022 short list.

The article is a case based format, stemming from a real consult in which a patient used a racial slur, and there was no response in the moment. What follows is a very open portrayal of the debrief, which touches on the harm caused and the missed opportunities for responding in a way which supports the anti-racist work we should be supporting in health care. I am so appreciative of the thoughtful and honest writing by the authors. It was difficult for me to read the first few times, because I would frequently reflect on missed opportunities I have had in my career. It hurts to reflect on moments you could reduce harm to others, but you didn't. This is an important step, and it gets easier to read, because you can focus on the framework McKillip and Moss give to make better choices in the future.

One critical point is our communication tools of empathic silence and immediate debrief are not enough to handle these situations. McKillip and Moss let us in on their inner thoughts as they work through this case. They did a lot of work together to make things better for their own future work alone and together. They could have kept this work private, but they transformed it into something that could have a much larger impact in the world. I am so appreciative. I have already put some of their work into practice.

This article differs from other important work like the 2016 NEJM article Paul-Emelie, Smith, Lo and Fernández, "Dealing with Racist Patients." Most articles focus on what to do about the care of the patient now and in the future if they ask to be reassigned. That is important to consider as well, but what I appreciate about McKillip and Moss' work is that it focuses on the team, and the role we all must have in working towards a more caring and supportive community at work.

COI: Peer-to-peer mentorship - Mckillip, Bazelak

*Friday Chalk Talk is a great weekly resource. I need to write about that too!

For more Pallimed posts about race and healthcare.
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For more Pallimed posts by Dr. Sinclair click here.



Christian Sinclair, MD, FAAHPM is palliative care physician working in outpatient clincs at the University of Kansas Health System in Kansas City, KS. He currently is inspired to learn more about low-car transportation planning in cities like Berlin.

Monday, January 17, 2022 by Christian Sinclair ·

Monday, January 3, 2022

Cloaked Suffering

by Lyle Fettig (@FettigLyle)

The suffering in our hospital is cloaked by tinted windows and shiny new steel, a serene architectural specimen which betrays the internal chaos of each person who experiences illness behind each door.

Even for people who work there, it is sometimes surreal to approach the building in its beauty with the dissonant knowledge of what can happen in all manner of disease in between the walls. It’s the perfect place to hide the devastation of a pandemic.

Were the death and agony in the streets for all to see, perhaps the choices that are obvious to you and me would be obvious to all. How could a person not take every step they could to prevent this ongoing calamity?

This is not the bubonic plague to be seen in the gutters but rather a plague silenced by the plastic of the tubes you have placed in many airways hoping that after days, Weeks, Months, those voices will be heard again, knowing that some will go unheard for all of eternity.

Speak the truth with the ferocity and compassion I always hear from you. Tell the world what you have witnessed. Then go back into it with pride that no matter how your message has been received, you can rest your weary head knowing you have done the best this world will allow.

Originally published on Twitter Dec 27, 2021



For more Pallimed posts about COVID.
For more Pallimed posts by Dr. Fettig click here.



Dr. Lyle Fettig is an Assistant Professor of Clinical Medicine in the Department of Medicine/Division of General Internal Medicine and Geriatrics. Dr. Fettig directs the IUSM Palliative Medicine Fellowship and works clinically with the Eskenazi Health Palliative Care Program.



Monday, January 3, 2022 by Pallimed Editor ·

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