What does it mean to be named an Emerging Leader in hospice and palliative medicine?
For much of the last five years, I’ve focused my attention on interprofessional education and communication training. Teaching with talented interprofessional colleagues has brought me some of the greatest joy in my practice. Being named an Emerging Leader in hospice and palliative medicine tells me our work of building collaborative, inclusive and integrated healthcare teams is valued.
Joining this group of emerging leaders leaves me feeling humbled and grateful, but mostly hopeful because our combined efforts can enact meaningful change. My godfather died last year from complications related to his dementia. In the days after his death, as my godmother reflected about his years of community service, she shared this quote (attributed to various Jewish scholars and the Talmud):
“Do not be daunted by the enormity of the world’s grief. Do justly, now. Love mercy, now. Walk humbly now. You are not obligated to complete the work, but neither are you free to abandon it.”
In our work, the inevitable suffering we encounter can be a heavy burden to carry alone. At the end of each day, I know my work is just one part of a whole and I’ve learned to celebrate our collective success.
Describe how you became interested in hospice and palliative medicine and who/what influenced your work.
Growing up, my parents were vocal proponents of service and social justice. We canvased for candidates, delivered meals or protested for better teacher pay. I saw a career in medicine as another way to address social inequities. I loved the initial years of medical school, but things changed during my third year. On my surgery rotation, our 10-person team entered a woman’s room who had a kidney transplant. She had diligently written down 4 or 5 questions on a post-it note. After the first few, the head surgeon said, “That’s all we have time for today” and turned around and walked out with the whole team following. In that moment, I was ashamed to be a doctor. That year I saw many more patients experience harm in what others might interpret as innocuous interactions.
In my fourth year, another surgeon introduced me to the work of physician and former head of CMS, Don Berwick. In his book, Escape Fire, Berwick said, “Healthcare tends to regard human interaction more as a toll or price than as a goal or product.” In his proposed model of care, “Interaction is not the price of care; it is the care itself.” On a palliative care rotation, I saw Berwick’s model in action. I watched skilled clinicians integrate narrative person-centered care with a passion for systems change and realized I found my people. Shortly thereafter, I joined what I consider to be a social justice movement and applied for palliative medicine fellowship.
What is your vision for the future of hospice and palliative medicine?
Palliative care clinicians are a valuable, limited resource and cannot meet the growing demand in our communities. While I think that our field fills important gaps in healthcare, I worry that additional specialists further fragment care at a time when people want and need care that is consolidated and coordinated. As I look to the future, I think our field will achieve this by increasing primary palliative care capacity and shifting our workforce even more towards 1) systems, policy and research leadership for creation and implementation of innovative, interprofessional, care delivery models and 2) educational coaching that continually trains and mentors practicing clinicians.
As an example, our palliative care team at Providence Health and Services of Oregon is creating an interprofessional educational arm. Our education team, in collaboration with the University of Washington Interprofessional Graduate Certificate in Palliative Care, is training palliative care champions in our primary care clinics. Our palliative care team then provides ongoing coaching support for these champions to implement clinic wide initiatives that train all staff in serious illness communication, advance care planning, complex care coordination and symptom management. Picturing what is possible in primary care empowers these clinicians, brings broader purpose to our work and increases access for all people with serious illness.