As hospitalists, we encounter these situations regularly, maybe even daily. Half of Americans die in hospitals, and 98% of Medicare beneficiaries who die spend at least some time in a hospital in the year before death (School, 2000, #1006). We are the physicians who care for the seriously ill and the dying. The question is not whether we will take care of these patients; rather, when we do, will we be ready and able? A survey of hospitalists found that we recognize the importance of palliative care to our practice, but that we feel that our training did not adequately prepare us to provide this care (Plauth, 2001, #763). Our core curriculum, which you will see in early 2006 as a supplement to the 1st volume of the Journal of Hospital Medicine includes a chapter on palliative care.
In many ways palliative care is easy, and in many ways it is difficult. Yes, it takes time. Conversations like the ones with Mrs. T. cannot happen in 5 minutes. But an investment of time up front to talk with patients and their families about preferences for care can save many hours down the road. And yes, these discussions are challenging. It’s not just patients who don’t like to talk about death and dying, their families and physicians don’t like it either. But we can learn how to conduct these discussions better and can practice phrases that will help them go more smoothly. Pain and nausea can be difficult to control. Yet, palliative care experts report that pain can be relieved with simple medications like morphine in more than 95% of cases. As hospitalists, we can fulfill our sacred duty to the sickest patients by learning these critical palliative care skills.
SHM has provided learning about palliative care at most annual meetings and will continue to do so in the future. We will also work on providing many more educational materials targeted specifically at hospitalists. Many CME courses across the country focused on palliative care, including those sponsored by the American Academy of Hospice and Palliative Medicine (www.aahpm.org), which also offers many educational resources on its Web site. Many hospitalists have already participated in Education in Palliative and End-of-Life Care (EPEC) (epec.net), a comprehensive, well-regarded curriculum in palliative care that you can purchase on the web. There are textbooks in palliative care, including the Oxford Textbook of Palliative Medicine, 3rd edition, edited by Derek Doyle, Geoffrey Hanks, Nathan I. Cherny, and Kenneth Calman, and Palliative and Supportive Oncology, 2nd edition, edited by Ann Berger, Russell Portenoy and David Weissman.
With skills in palliative care, we can make a profound difference in the lives of our patients and their families. What is it worth to be able to say good-bye and “I love you” to your family? Mrs. T.’s husband was profoundly grateful for the opportunity to say those things and more to his wife before she died. And although his wife died in the hospital, he was exceedingly satisfied with the care she received. Relieving symptoms for seriously ill patients and talking with them about profound and important issues is not only good for patients; it is good for us, too. Providing high quality care to seriously and terminally ill patients can provide a deep sense of fulfillment and satisfaction through the real and intimate engagement with our fellow human beings. It also allows us to use our humanism and to connect directly to the reason that many of us chose medicine as a career— to help people. In this way it can also protect us against burnout.