Wednesday, November 16, 2011


NEWS REPORT: Doctors overwhelmingly support palliative care at end of life.

SAME REPORT: Doctors say patients aren’t well informed.

READING BETWEEN THE LINES: If the patient isn’t well informed, what does this say about the doctor? And what is it about palliative care that is beyond the skills of other specialists?

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A joke in my household has gotten so old that even I, who stubbornly clings to anything vaguely humorous, am letting it go. Perhaps this will be the last telling.

The joke starts with an innocent question directed toward the kitchen: What time is it? There are two clocks there, one on the oven, the other on the microwave. If they weren’t reset after the timer’s last use, they simply read “END.”

And so the answer to What time is it? has become, It’s the end of time. When this is the answer, It’s the end of time invariably is followed by Hasta la vista, sometimes Finish what you’re doing, honey, or my personal favorite, Off we go, then, in a pitched, faux British accent.

Alas, the joke has run its course. Certainly my wife and daughter feel that way. So I’m ready to let go.

I’m thinking about letting go and the clock running out while reading a story on that says doctors overwhelmingly support palliative care, want it to become a higher priority for patients who need or want it, but are put off by the “giving up” baggage carried by palliative care.

According to the survey, “Two-thirds of the physicians who have discussed palliative care with their patients say the patients are not well-informed about their options, and about a quarter say they're reluctant to recommend palliative care because their patients may believe they're not doing everything possible to extend their lives.”

There’s no question that some humans lack, or even resist, reasonable understanding, especially in a health crisis. (Just google “death panel.”) But what percentage of those physicians with “not well informed” patients would question their own ability to inform well. How many are good listeners who know the patient as well as they know the disease? How many would be described by a patient, or surrogate, as “not well informed.”

For some, palliative care carries the stigma of giving up. And yet studies show palliative care improves a patient’s quality of life, sometimes with the added benefit of more time.

So why is palliative care stigmatized, to the detriment of patients who would benefit and caregivers otherwise out of good options? Maybe it’s because it often is misunderstood as an end-of-life specialty, and not the broad spectrum of comfort care that it is. And because patients and surrogates want the problem to go away, not merely become more tolerable.

Palliative care isn’t exclusive to the end of life, but in a medical world better at understanding the parts than the whole, palliative care is often considered only when other, more specialized options have failed. That it is seen to exist in the handoff from doctor to undertaker is as wrong as it is sad.

Palliative care physicians consider the whole patient, the whole person, not simply the troubled parts. Communication is part of the practice. In modern medicine, they’re kind of old school.

Palliative care can help with the “not well informed” problem, especially when it enters the conversation early. Maybe we need a national Take a Palliative Care Physician on Rounds Day. Palliative care physicians are good at talking and, especially, listening. And isn’t that how one becomes “well informed”?

So, anyone got the time?


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