There Until the End


Patients with advanced cancer who have end-of-life conversations with palliative-care physicians have lower treatment costs, according to a March 9 report in the Archives of Internal Medicine (2009;169(5):480-488). Two other articles in the same issue examine dying patients' feelings of abandonment by physicians.

As more hospitalists move into palliative care, these studies confirm that working with patients in their final days is beneficial for the patient and the hospital.

Take a recent case at Meriter Hospital in Madison, Wis.: A ventilated patient in the hospital's ICU had been receiving aggressive treatment until a palliative-care hospitalist was brought in for a consult. The patient could barely communicate because of the tube in his trachea and an inability to raise his arms; however, the hospitalist took the time to understand the patient's wishes.

"It was very clear he [the patient] had had enough," says hospitalist Amanda duPreez, MD, medical director of Meriter's palliative-care team. "He was ready to die. Had we not been invited into that conversation, it would have been several more days."

Dr. DuPreez thinks hospitalists on palliative-care teams are a natural extension of HM's goal to reduce patient length of stay and contribute to fiscal efficiencies.

"First and foremost, how do we help improve the quality of your life?" Dr. duPreez asks. "Just by nature of [asking that question], there are subsequent cost savings. The intent is never to go out and slash costs across the board. It's a natural byproduct of sitting down with your patients and asking where they're at."

Dr. DuPreez's palliative-care team is looking to recruit another hospitalist because its five-member group has seen its consultations nearly double to more than 30 per week.

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