What is Palliative Care?
At PPC we are a certified palliative care practice, and we strongly believe in the precepts of the palliative care model. A peer-reviewed article Dr Lazris wrote about geriatric palliative care explains the basic precepts of a palliative mindset and how it typically leads to good outcomes in older people with chronic illness. At PPC we believe that palliative care and good care are synonymous.
What is palliative care? Isn’t it hospice, and isn’t’ hospice designed for those about to die?
Well, no and no. Hospice is palliative care, but not the other way around. Hospice is a Medicare benefit offered when people are deemed to have less than 6 months to live. When you accept hospice you get extra help but you also give up a lot, such as the ability to get physical therapy and other testing. Hospice is most effective when you need special equipment that Medicare won’t otherwise supply, or when you are in dire pain. Beyond that, it is palliative care with restrictions.
Palliative care is often called gentle care, slow care, or care focused on symptoms and function. It is good care! When we follow the dictate of Willian Osler—treat the patient, not the number—and we speak with our patients, listen to their concerns, observe what is impairing their function and their overall sense of wellness, then we can forge a treatment plan that helps them feel better. And if we do that—focus our gaze on them as human beings and not on them as a collection of measurements—copious data shows that our patients will feel better, function better, and maybe even live longer.
Yes, an approach to care that is all about comfort and function actually has been shown to extend life. As we trim back medicines, test based on symptoms, treat symptoms with as holistic approach as possible, then older people do better. This is especially true in chronic illness such as congestive heart failure, coronary artery disease, emphysema, and arthritis. We don’t reject tests and pills, but our essential mission is to avoid interventions unless they are in the interest of comfort. As an example, in several studies fewer congestive heart failure patients decompensated and went to the hospital and died when treated with palliative approach to that condition, an approach that divorced them from their cardiologist, eschewed echocardiograms and other sophisticated tests, and relied more on their weight, their swelling, and how they felt to dive treatment. That’s palliative care.
Something we call the “palliative effect” exemplifies the benefit of palliative care and difficult it is to accept by many patients and families accustomed to the test-diagnose-treat number-based mentality of the American health care system. For instance, let’s say that a patient of ours declines, she doesn’t eat, she can’t move, she is more confused. Her family is very concerned, bringing her to an army of specialists, test after test, medicine after medicine, they try to feed her and walk her, and she just gets worse. So, finally, as she can barely even open her eyes, they call in hospice. We then stop all her medicines, stop her visits to specialists, and let her eat when she wants to eat, with her family focusing on loving her rather than badgering her with a medicalized hammer. Within two months, she is eating well, standing up, speaking more clearly. That’s the palliative effect, and that is a true story, but one with a funny ending. When the patient was dismissed from hospice after, well, being too well, one of her daughters asked us: Now that mom’s better, shouldn’t we get her back on all her medicines, and at least make sure her cholesterol is ok? When should she see her cardiologist?
It was difficult to understand that once we didn’t concern ourselves with visits and tests, numbers and medicines, that when we treated the patient as a human being with autonomy and dignity, only then did she get better. When we medicalize a person, when we carve them up into organs and numbers, they don’t do well. In a gentle, sensible, and scientific palliative model, we take care of her as a human being. We don’t care what her cholesterol is and we certainly don’t want to have her schlepped to doctors and tests. We want her comfortable, functioning, and empowered.
Through our PPC palliative program we will provide a palliative consult and follow-up, speaking with our patients and their families about diagnoses and medicines, advanced directives, and goals of care. We will script a plan that reduces their drug burden, releases them from the shackles of an overwhelming and frightening medical system, discuss ways to improve their mind and function, and begin the process of healing.
It’s a leap of faith, but palliative care is patient-centric, gentle, geriatric care. Let us know and we’ll sit down and discuss the palliative approach. In the end, the only thing you have to lose is a lot of time worrying about medical problems and taking medicines! Watch our Video to learn more!
Read Dr. Lazris' article on Geriatric Palliative Care: Article Link