Palliative Care Grand Rounds 2.9

Welcome to the monthly edition of Palliative Care Grand Rounds the monthly review of the best of hospice and palliative care content from blogs. We started in February of 2009 and are almost done with our second full year. To see previous editions of Palliative Care Grand Rounds go the

Marten Creek Photo by Joan Robinson RN CHPN Seattle WA

This summer has been a exciting month for palliative care and hospice advocates. At the beginning of the month we were still taking in all the attention form Atul Gawande’s article in the New Yorker titled ‘Letting Go.‘ And then in the middle of August we had the ground breaking research published in the NEJM demonstrating early palliative care improves QOL, reduces depression and potentially can improve survival.

So I thought we could start with blog posts relating to those two big tent poles.

The Gawande Article

People were reflecting on the writing of Atul Gawande and I think there is a lot to learn from how he tells his stories. It may help in how you give a presentation or write articles or blog posts of your own. My favorite was a blog called ‘Not Exactly Rocket Science’, where blogger Ed Yong writes on ‘Deconstructing Gawande – why structure and narrative are important.’ Also check out Bob Wachter‘s blog piece on Atul Gawande and the Art of Medical Writing. He writes:

In this month’s piece, Gawande continues to tackle the most important healthcare issues of our day. By doing this with such clarity and beauty, he makes us all a little smarter, wiser, and more sensitive. His writing is a gift.

Debra Bradley Ruder from the GrowthHouse blogs Goodbyes writes on the Gawande article as well.

The NEJM Study

Both Geripal (Alex Smith) and Pallimed (Lyle Fettig) jumped on the NEJM research quickly and provided really helpful insights into the research that you wouldn’t get just reading the New York Times or other media sources. Between these two posts there are currently over 35 comments! Several days later Drew Rosielle let the results marinate with him a bit and the result is a tasty dessert highlighting the implications for our field in his Pallimed post ‘You had me at improves HRQOL.’

Diane Meier jumped into blogging and wrote a good piece at the John Hartford Foundation blog, that was picked up my the (general medicine) Grand Rounds and got 2nd billing. Many other key blogs covered this as well including:

Other great bits

Each person faces cancer in his or her own way. There is nothing right or wrong about the different approaches people take. Denial or acceptance is not a statement about someone’s character. Having hope or not does not always come from an explicit decision to be hopeful; it often just happens one way or the other. Likewise, the spectrum from stoicism and strength to dependence and, yes, even weakness, are reactions that are unpredictable until you are actually faced with the disease. Too, how one feels can change over time — whether minute to minute, day to day, or year to year. So, one thing I have learned is not to be judgmental about how a person responds to cancer.

It is doubtful that a focus on reducing EOL spending per se will result in as much savings as is often assumed, for one simple reason: The concept of the last year of life is inherently retrospective. You do not know when the last year of someone’s life started until it ends. The stylized fact that leads to the assumption of wasteful EOL spending., i.e., 1 in 4 dollars spent on care in the last year of life, is based on an inherently retrospective concept that does not translate easily into the prospective decision-making that would be needed to reduce wasteful, futile or harmful spending in the last year of life.

And then I understood. I wasn’t crying for him. I was crying for me.

I cried because I couldn’t imagine a memorial service for me looking anything like the one for Rob. I cried because I couldn’t imagine that twenty people, let alone two hundred, would give up an evening to say nice things about me. I cried because I couldn’t imagine that my life, already a lot longer than Rob’s, would ever have that kind of meaning and impact. I understood then that my patient’s short life was telling me to live the rest of my own life better — to be warmer, and more open-hearted, and more loving.

people—actually mainly men—wished that they hadn’t worked so hard. They “deeply regretted spending so much of their lives on the treadmill of a work existence.” My wife would say that I work all the time, but I live a life where work and play are not easily distinguished. Is writing this work? It doesn’t feel like it to me. Tomorrow I’m off to give a talk at a science festival in the Austrian Alps. Is that work? The truth is that even in the most serious jobs I’ve always let the appealing (and often frivolous) come before the serious.

Some humor

Oscar the Cat - Photo by Stew Milne of AP.

So as you can see there are many people talking about the difficult things people don’t want to talk about. We are not alone in wanting to provide good quality care for patients and families facing with life-threatening illness. Sometimes with a little humor is a tough time, sometimes with fantastic insights into what it means to be alive. Go read and support the things that impact you with a comment, Facebook ‘like’ or email to a colleague.

Check out next month’s host the SWHPN blog called palliative-sw. They have a new look!

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9 thoughts on “Palliative Care Grand Rounds 2.9

  1. Christian,
    Thanks for keeping us updated.
    Our operations committee had just completed the book about Oscar and found it most helpful in our day to day family meetings. The article by Dr. Gawande has allowed for more discussions and the organization I work for has taken this to a new level. Excited to see what comes next.

  2. “palliatician” – this is a new word with real possibilities, given the struggle we are all having right now to succinctly convey what docs in this field do. Problem is – the public won’t know what it means – yet. But then, does the person-on-the street know what an otolaryngologist does? At least palliatician has fewer syllables.

  3. Thanks, Christian. I especially loved the blogs on medical writing – I would never have seen them without your help! And, I finally watched the “take out the trash” video. And that led me to the orthopedic/anesthesia video that made both my husband and me laugh out loud.

  4. Eric, Barbara and Gail

    Thanks for the encouraging words. I have bot read the Oscar book yet, and though it might be too cheesy to us in the field, but you have made it seem more relevant. I will have to check it out. Gail, I think the medical writing articles are fantastic reference pieces. They need to be read by more physician authors.

    I was going to show you the Take Out the Trash video in CHicago last month Gail but we never got around to it. I think someone should fit it into the annual assembly next Spring.

  5. Dale,

    Wow, I threw out ‘palliatician’ as an off the cuff portmanteau of palliative and politician, and someone liked it. Wasn’t sure if it would resonate with anyone. You bring up a great point that the public has actually learned many difficult words and has begun to understand them with repeated exposure. Look at these medical words:

    I think a lot of people can readily identify what these terms relate to and what they mean. But I never thought ‘palliative medicine doctor’ sounded right. Too long, just like ‘internal medicine’ doesn’t sound quite right. I do have to say I was kind of intrigued when someone mentioned on Twitter that they saw their Pallimed doc.

  6. To Christian, Palliatrician:
    Read the Oscar book. Dr. Dosa’s got the right stuff. No matter what you think about the cat, the story’s about humane, quality palliative/EOL care, delivered in (amen!) LTC.

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