Director of Palliative Medicine, Johns Hopkins Medical Institutions
Professor of Oncology, Sidney Kimmel Cancer Center
Dr. Smith has not spent the bulk of his career at Johns Hopkins, as many of his colleagues have. In fact, he joined the faculty at Hopkins mid-career with one primary goal in mind: to enhance its palliative care program.
Palliative care is a relatively young medical specialty. It was only declared a board-certified specialty in 2006. But an increasing number of hospitals and academic centers are beginning to recognize its importance. As a pioneer in palliative care who has dedicated his career to it, Dr. Smith is ahead of the curve. “I think of palliative care as being open and honest in communication with patients, as setting medically appropriate goals, and the best symptom management,” Dr. Smith says.
Too many physicians, explains Dr. Smith, avoid uncomfortable conversations regarding pain and difficult decisions about patients’ future. “Oncologists as a whole don’t like to bring up these issues at all. If we do, we tend to bring them up when it’s too late,” he says. “I’ve learned to address these issues farther upstream.”
The issues to which Dr. Smith refers are sensitive but significant, and include things like future decisions about life-support, hospice versus home care, and even patients’ remaining goals. Talking with patients about these subjects when they can adequately ponder them, that is, when they have six months or even two years to live, can make an enormous difference to their quality of life.
Proof exists of palliative care’s effectiveness. Dr. Smith refers to studies demonstrating that oncology patients who receive palliative care alongside regular care have better symptomatic management, less depression and anxiety, and better overall quality of life. They may even live longer.
He also believes that Johns Hopkins is on the cusp of fully embracing palliative care and its rewards. “The whole place is ready. We think Hopkins has the potential to become a national leader [in palliative care] in the next five years,” Dr. Smith says.