Right care, right time
Date: February 9, 2012
To Paul Gleichauf, starting a palliative medicine program at Howard County General Hospital was just good medicine and good business.
“If you look at pain control scores on our patient satisfaction survey results,” says the hospital’s senior director of planning and marketing, “there was some opportunity for improvement. Palliative care is a tremendous technique supported by evidence-based medicine that makes marked improvements in pain management.”
Gleichauf also points out that with the assistance of palliative medicine, patients’ physical and emotional discomforts can be addressed and better managed, helping to avoid costly readmissions.
So last August, Howard County General Hospital launched its new Palliative Medicine Program, in cooperation with the palliative care team at Gilchrist Hospice Care. The program focuses on improving the quality of life for those with chronic, debilitating and life-limiting illnesses.
“Palliative medicine helps with treatment options,” explains Danielle Doberman, a board certified hospice and palliative medicine physician and director of the Palliative Medicine Program. “I evaluate what is going on medically in the patient’s body, and I explain what is happening in lay terms. Other members of the team focus more on family support. Together, we assist the patient and family with merging their personal goals with health care reality. The nurse practitioner and I also evaluate a patient’s physical comfort.”
Care is provided by a multidisciplinary team made up of a physician, nurse practitioner, social worker and chaplain. The team focuses on relieving pain and other physical symptoms, preventing emotional and spiritual suffering, and facilitating patient and family meetings to define goals of care, including advance directives.
According to Doberman, many palliative medicine patients have family members who are at crossroads. “We see patients and families facing an emotional crisis—perhaps an adult child is having trouble coming to grips with their mother’s decision about her medical care,” she says. “We also see those dealing with a physical crisis such as a chronic illness in an acute flare state where medical treatment options need to be weighed.”
Palliative medicine also assists patients who have end-stage illnesses, such as cancer, by addressing symptom-management techniques and advance directives. This highly sensitive time is a perfect illustration, says staff critical care physician Nishi Rawat, of the powerful impact that the program has on patients and families.
“There is always tension between life and death in the ICU. We attempt to bring patients back from death’s door aggressively; when we are unsuccessful, we engage families in discussions about death and dying,” Rawat explains. “These conversations can be very jarring, and the palliative medicine team smoothes the transition by keeping patients and families informed, opening communication channels and serving as a source of strength. Many times, patients have never discussed dying or making health care decisions that can radically change their lives; the Palliative Medicine Program helps bring patients and families together on the same page, navigating emotional conversations and choices.”
— Kyri Jacobs