From the Society

Hospital medicine and palliative care: Wearing both hats


 

The primary focus of SHM’s Palliative Care Work Group is educational. That is, we aim to assess and help meet the educational needs of hospitalists, thereby helping to empower them to be outstanding providers of primary palliative care to seriously ill, hospitalized patients. To that end, we were very proud to orchestrate a palliative care mini-track for the first time at HM18. To our group’s delight, the attendance and reviews of that track were great. Thus, we were invited to further expand the palliative care offerings at HM19. We are busy planning for HM19: a full-day pre-course in palliative medicine; several podium presentations which will touch on ethical challenges, symptom management, prognostication, and other important topics; and a workshop in communication skills.

What led to your dual certification and how do your two specialties overlap?

I am board certified in internal medicine with Focused Practice in Hospital Medicine by virtue of my clinical training and my primary clinical practice as a hospitalist. As a hospitalist in a cancer center, I spend most of my time caring for patients with late- and end-stage malignancy. As such, early in my career, I had to develop a broad base of palliative medical skills, such as pain and symptom management and communication skills. I find this work extremely rewarding, albeit emotionally taxing. I have learned to redefine what clinical “success” looks like – my patients often have unfixable medical problems, but I can always strive to improve their lives in some way, even if that means helping to provide them with a painless, dignified death as opposed to curing them.

When the American Board of Medical Specialties established a board certification in Hospice and Palliative Medicine, there briefly existed a pathway to be “grandfathered” in, i.e., to qualify for board certification through an examination and clinical experience, as opposed to a fellowship. I jumped at the chance to formalize my palliative care skills and experience, and I attained board certification in 2012. This allowed me to further diversify my clinical practice here at MSKCC.

Hospital medicine is still my first love, and I spend most of my time practicing as a hospitalist on our solid tumor services. But now I also spend several weeks each year attending as a consultant on our inpatient supportive care service. In that role, I am able to collaborate with a fantastic multidisciplinary team consisting of MDs, NPs, a chaplain, a pharmacist, a social worker, and integrative medicine practitioners. I also love the opportunity to teach and mentor our palliative medicine fellows.

To me, the opportunity to marry hospital medicine and palliative medicine in my career was a natural fit. Hospitalists, particularly those caring exclusively for cancer patients like I do, need to provide excellent palliative care to our patients every day. The opportunity to further my training and to obtain board certification was a golden one, and I love being able to wear both hats here at MSKCC.

Ms. Steele is a marketing communications specialist at the Society of Hospital Medicine.

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