Session 69

In today’s episode, Ryan and Allison talk about end-of-life care, which can affect everybody in medicine, whichever point of the medical career path you’re in, especially as a resident and a practicing physician wherein you will be encountering patients who are moving forward or at their end-of-life that involves a lot of medical care that really needs to be addressed.

For premed students, this could be a potential topic during interviews where a lot of ethical questions can be drawn out from this.

Here are the highlights of the conversation with Ryan and Allison:

Palliative care, defined

• To make a disease or symptoms less severe or unpleasant without removing the actual cause of the disease itself.

Palliative Care: Its Origins

• Began with the Hospice Movement
• Taking care of dying people has been going on for a while
• In the U.S., palliative care began at Cleveland Clinic and the Medical College of Wisconsin in the 80’s
• 80% of U.S. hospitals with over 300 beds have a hospice program

What qualifies for hospice?

A patient that would no longer live more than 6 months as assessed by a primary care physician

Factors for palliative care:

• Futility
• Quality of life

The “we can treat” mindset:

• Out of 120 U.S. cancer center hospitals, only 23% of them have beds dedicated to palliative care.
• We can’t fix anybody and anything.

A New England Journal of Medicine in 2010 talked about lung cancer patients with these findings:

Patients who received early palliative care experienced less depression and increased quality of life and survived 2.7 months longer on average than those receiving standard oncologic care

Why palliative care is important:

Helps improve the comfort of the individual and freedom of pain, discomfort, and anxiety

The misconception of palliative care as “pulling the plug” or withdrawing care:

These terms are widely used but you need to understand that withdrawing care implies removing care from the patient. So this clearly indicates a lack of understanding about end-of-life care because it leaves the patient and the family with a feeling that you’re not caring for them anymore.

Shifting Your Goals of Care:

You’re still caring for the patient but it’s all about a shift in your goals of care. So you are not “withdrawing” from care. You are still actively managing the patient to aggressively maximize the patient’s comfort. Goals of care is a very important concept you can carry with you in your medical training.

Some pieces of advice for premed students:

Be informed. You will run into terminally ill patients who need your help. When you do have opportunities to receive this kind of education in medical school and as a resident, take in as much as you can.

Go and find a family meeting to be a part of and observe. Go to a palliative care talk and find a palliative care team at your hospital and get some experience with that.

Links and Other Resources:

New England Journal of Medicine 2010 article: Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer

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