Hospice & Palliative Medicine
By Kim Dianich, PHR, PeaceHealth Medical Group, Bellingham, WA, firstname.lastname@example.org; with Margaret A. Jacobson, MD, Medical Director, Whatcom Hospice, Bellingham, WA.
Hospital-based palliative care programs have existed since the early 1990s. However only in the past couple of years have hospitals and health systems begun to implement official, structured palliative care programs.
What is Palliative Medicine? How does it differ from hospice?
Palliative care focuses on improving a patient’s quality of life by managing pain and other distressing symptoms of a serious illness. Palliative care should be provided along with other medical treatments once a chronic life-limiting condition is diagnosed. Hospice care is palliative care for patients in their last year of life. Hospice care can be provided in hospice centers, hospitals, long-term care facilities, or wherever a patient resides.
How does a palliative care physician differ from other physicians?
Palliative care physicians work as part of a team to provide expert pain and symptom management to patients facing chronic life-limiting disease. They consider the whole person while reducing the patient’s pain, relieving symptoms, and increasing their quality of life. Palliative medicine is, by definition, multi-disciplinary, and the “team” model is central to how palliative care is delivered. Palliative medicine physicians are skilled at facilitating the difficult end-of-life decisions that other physicians often don’t have time for. They are also adept at care coordination, both across settings as well as the continuum of illness.
Currently there are 73 one-year palliative medicine fellowship programs with an average of one fellow in training per program.
In 2006, the American Board of Medical Specialties approved Hospice and Palliative Medicine as a subspecialty of 10 co-sponsoring ABMS Member Boards: anesthesiology, emergency medicine, family medicine, internal medicine, obstetrics and gynecology, pediatrics, physical medicine and rehabilitation, psychiatry and neurology, radiology and surgery.
The first hospice and palliative care board exam was administered in November 2008. The “grandfather period” ends in 2012 for MDs and in 2013 for DOs. Beginning in 2012, a physician who wants to practice palliative medicine will have completed a residency and board certification from one of the 10 co-sponsoring ABMS Member Boards as well as an ACGME-accredited palliative medicine fellowship. The palliative medicine board exam will only be offered every other year.
“Adding Hospice and Palliative Medicine as an ABMS subspecialty is a great complement to so many of our areas of specialty medicine,” said Stephen H. Miller, MD, MPH, ABMS President and CEO. According to the ABMS, a total of 2,995 physicians have successfully received subspecialty certification in hospice and palliative medicine from one of the 10 co-sponsoring boards.
Palliative care physicians, in addition to their clinical skills, need strong problem-solving and communication skills. They need to have the ability to quickly assess a patient’s medical condition and to be able to translate that to the patient and the patient’s family. More importantly, however, they need to also be skilled in assessing psychosocial and spiritual needs as well. They work directly with an interdisciplinary team — other physicians, advanced practice professionals (ARNP/PA), nurses, medical social workers, chaplains, etc. Their work has a direct impact on hospital-based physicians from the ER, ICU, and hospitalists. They also coordinate care with outpatient primary care providers and hospice.
The palliative care physician also needs to understand what metrics are necessary to justify the program’s existence. Physicians hired in this specialty will not necessarily bring monetary profits to the hospital, therefore they need to understand measureable outcomes.
Health system motivation for implementing a palliative care program
A palliative care team cares for the patient’s (and family’s) emotional, physical, and spiritual well-being.
Better coordination of services for patient.
Provide better quality of life for patients.
Provides enhanced information and coordination for patients’ families.
Hospitals with palliative care programs have lower re-admission rates and patients have less repeat ER visits.
Patients who are followed by palliative care teams often make different choices about care in the ICU, especially if being there clearly will not help them improve. This results in less futile and non-beneficial care being offered to patients.
Palliative care physicians are generally compensated via salary versus on a production-based model. They spend a great deal of their time with the patient and/or family, listening to how they can help them and counseling them on how to navigate the system.
Sources for more information on hospice and palliative medicine