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Northeast Florida Medicine
Vol. 67, No. 1 2016
41
Palliative Care
“aggressive” is an adjective that may be associated with ag-
gressive curative as well as aggressive palliative; furthermore,
aggressive palliative, when applied early, often enhances
quality of life, extends life and reduces cost.
3,8,9
8. Collaborate with colleagues. None of us have all
the medical knowledge and skills or solutions. When
you’re scratching your head facing tough choices, turn
to a colleague for suggestions. Sometimes our emotional
investments in our patient unwittingly bias our percep-
tions. Also, studies have shown that neither doctors nor
family members are adept at guessing what patients want;
therefore, it is wise to consider a second opinion.
9. Care always. Patients and families deserve to know
more than just the facts. They need to know about the
person who utters the facts, the odds and all the percent-
ages. They need to know that the palliative care consultant
has a heart, a soul and an empathic perspective, most of
all. Sometimes it is better to start with “how much do
you want to know?” and “who should we visit about your
condition?” Sometimes, the factual “odds of success” are
specifically not what they want to hear. With empathy, we
aim for a modicum of healing even in the absence of curing.
10. Take care of your life while you help others live
well. It is not a luxury, it is a necessity. Physician burnout
is the ultimate paradox; those who serve others must “put
the oxygen mask on first, then help their seat-mate” as
instructed in the case of an air emergency! Fortunately,
caring for each patient is a hallmark in the world of hos-
pice and palliative medicine, as evidenced by the wealth
of resiliency and self-care didactics at the national hospice
and palliative care meetings.
Author Recommendations
and Conclusion:
Develop your own words in creating conversation-starters
to facilitate empathic communication among the participants.
Most people want all the information available regarding the
diagnosis, treatments, benefits, burdens, alternatives andodds
of success; however, not everyone. Therefore; start here:
• How much do you want to know about your
condition/treatment/prognosis?
• To whom should we speak about your situation
and who would you like to participate?
• What matters the most?
• Knowing what you know now, how would you
like to proceed?
• What tradeoffs are you willing to accept or reject?
11
5. Palliative care teams manage total pain. This is defined
as physical, psychological, emotional, spiritual, social, and
existential suffering.
6. Patients with a serious illness have many symptoms
that palliative care teams can help address.
7. Palliative care can help address the emotional impact
of serious illness on patients and their families.
8. Palliative care teams assist in complex communication
interactions.
9. Addressing the barriers to palliative care involvement:
Patient’s hopes and values equate to more than a cure. It
is critical to discover what matters most to the patient and
conceive a plan of care to meet those goals.
10. Palliative care enhances health care values.
Ten More Things
We Want Physicians To Know!
These ideas are from the authors’ perspectives:
1. It is OK to call hospice without us; really. Seek the
opinion of the palliative care consultants and the nurse
liaisons from hospice via the telephone to discuss enroll-
ment criteria and concerns about eligibility.
2. Ultimately, listening to the patient’s and families’
stories, narratives and goals to discover what matters most
is rewarding for all (including the care team; it is important
to acknowledge this).
3. Write a plan of care that meets the patient’s needs
consistent with their culture, religion, spirituality andworld-
view; their goals are our goals.Their hopes become our hopes.
4. It is never too early for ACP; it is only too late. Getting
a notice that your consult has been canceled because the
patient just died is not professionally or personally rewarding.
5. BE with the patient and family; it is not necessary to
DO something. Compassionate presence speaks volumes.
6. Listen with open mind and heart. When you respond
to their needs and concerns, you really are serving them.
As palliative care consultants, we are occasionally asked
to get the do not resuscitate order (DNR) or to otherwise
meet the referring consultant’s goal, which may not be
the patient’s goal. Our challenge is to remain constant, to
discern and to define the most important concern of the
patient, and to discuss and actuate their plan of care. In
this sense, we truly keep an open mind.
7. Talk less and listenmore. Assiduously and aggressively
assess, analyze, anticipate and alleviate suffering. Remember,