DB'S MEDICAL RANTS

Internal medicine, American health care, and especially medical education

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Palliative care, hospitalists and outpatient physicians

This week I will likely write some very personal entries. We admitted my 87-year-old father to the hospital last night.  He has what many physicians call the “dwindles”.  At this time he needs help with most all activities.  My mother performed these tasks for too long, and she is very tired.  I made the decision to get him admitted last night.

First I talked with his excellent internist.  My parents love these internist, and I have found him bright and concerned in our several phone conversations.

I had originally suggested palliative care, but I actually believe that he did not have previous experience with palliative care, and he quickly offered hospice care.  Now I am not the best physician at clarifying the differences between a palliative care approach and a hospice approach, but palliative care was really the key for my dad.

Last night I talked with a wonderful hospitalist.  She was most informative about his condition.  She suggested a palliative care consultation and I was delighted.  I will be flying to visit him tomorrow and hope to meet with the palliative care team then.

As I pondered my experiences trying to help my parents through this difficult time, I may have had a revelation.  I really need some experts to help here.  Palliative care has started primarily to meet inpatient needs.  Palliative care does provide excellent outpatient assistance, but I believe it generally starts from an inpatient evaluation.  Palliative care could move into the outpatient arena, but they appropriately receive some pay from hospitals.

I suspect that pure outpatient physicians have much less exposure to palliative care.  That may explain my disagreement with our favorite Dinosaur recently – Is palliative care a specialty?

As one who focuses his clinical time in the hospital, I am relieved and delighted that my father is in a hospital that has an excellent palliative care service.

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