Several years ago I was seeing a pain specialist due to almost constant low back pain. He ordered some xrays, which showed no reason for the pain. He performed several other tests, sent me to do some pt, all to no avail. He finally said, basically, “you’re overweight and don’t get a whole lot of excercise, and your back is responding accordingly.” He put me on tramadol and Motrin and saw me for 30 seconds every month, handed me a script and we were done. Rinse and repeat for 18 months.
Now, I understand you’re a physician and it sounds like your work situation is unique - you are part of a hospice care service that must call itself palliative care for subtle legal reasons. However, what my pain doctor was performing was true palliative care: treating the symptoms but not the underlying cause.
Hospice agencies perform palliative care, but it’s a very specialized form of it. It’s simply incorrect to assume that palliative care means end-of-life care. The two aren’t the same thing.
I think part of it must be that, in general, when you see the patient, you already know that they’re dying. So there wouldn’t be the same sense of theft or outrage or hope torn away as you get when it’s your loved one, who you’ve known a long time in their health and vitality, who becomes sick and dies. With that given, I can see how palliative care specialists could instead find their work very rewarding and enriching, what with relieving pain, preserving dignity, and making a very difficult time easier.
The palliative care nurses we have at the Hospital are some of the most fantastic, strongest, amazing people we have. They truly are a relief for our patients, they assist with some of the most “difficult” things that (Internist at least) Physicians themselves dread having to do. Discussing end of life issues is a difficult thing to do, and there’s sometimes a stereotype among older docs that it’s “giving up”, but it’s being drilled into the younger classes that Palliative care is NOT end of life care, that we should call them if we need palliation or if we need to discuss pt needs/goals of care, because at times it’s easy to assume the pt wants full medical care, they want everything to be fixed, because that’s what we may want in their shoes.
The Palliative specialists do an excellent job of talking to the patients though, understanding where they’re coming from, their goals of life, and where they see themselves at the end of this road, and they have the tough conversations that the Medical team may be too afraid to bring up sometimes. Anyone who views it unable to hack it or not like the rest of the Doctors, they’ve likely never had the need to call for a palliative consult on a patient with a terminal illness and had to break that sort of news. Sometimes in medicine, less is more for the patient, and Palliative people are a special kind of person.
It’s like Psychiatry in that it takes a different person though to be willing to go into the field and it’s an emotionally draining field, I cannot imagine how they do it. Often times, they’re treating the Medical Treatment team as much as they are the Patients as well…
The first time I had to call a time of death on a patient, I just felt sick afterwards for the next day or more, and I ended up just walking over during lunchtime to talk to the Palliative Docs we had. It was a wonderful conversation, ended with a few hugs, and I def. felt better about why I do what I do. They’re wonderful people, 'nuff said.
Like any other profession, some are good at what they do, and some are there because they couldn’t find anything else. I have known some terrific people in that line of work, and some who just suck. Like any other job.
Yes, I have rotated with a palliative care physician and I was blown away by the skill and compassion that she had. It’s not easy telling someone “The odds are that you have less than six months to live” (or less - although technically hospice is for someone who has less than six months to live, the reality is that most of the time by the time palliative care gets involved the patient has much less time than that).
While there is a popular image that doctors want patients to keep having aggressive treatment even though the patient wants to give up, I have found that isn’t always motivated by the doc. Sometimes the patient and/or the patient’s family are in severe denial of how bad the prognosis is, even if it’s clear to outsiders that things don’t look good. That makes the conversation a lot harder than if it’s someone who is at peace with their imminent death.
I have never seen a case where I regretted calling a palliative care consult. I HAVE seen many cases where I wish palliative care had gotten involved sooner. I have a huge amount of respect for palliative care and hospice professionals. Alleviating suffering is as important as “curing” (which we really don’t do all THAT often in many branches of medicine, honestly).
My father has a palliative care professional come in three days a week. I’ve become amazingly thankful for what they’re able to do for him and my mother. I wouldn’t say I’d specifically give a ‘noble’ reaction, but certainly ‘dedicated’.
(Though, on hindsight, I’m sure like any other profession there are those that are more dedicated than others).
I’d say it’s just as heartbreaking a task as pediatric oncology.
The idea that their fellow medical professionals might think that the courageous people involved “failed into it” is new to me, and to be honest I find it a bit disgusting.
The work is both noble and depressing.
These people are true heroes who do a job I can’t even imagine.
I think you have to be really grounded, and have come to terms with your own mortality to do it. Requires enormous emotional maturity, and vast patience. An instinct for kindness is pretty much a given.
You don’t need to be religious to have a sense that there is something …holy… about what they do.
Exactly. I’m not religious, but my beloved grandma sure was. She thought she knew where she was going and the hospice care helped her get there with as little pain and as much dignity as possible. Bless you Karen and Heather - and everyone else who does your kind of work as well as you do - for being smart and kind and helpful. I can’t imagine why anybody would say #3 on the poll.
I don’t understand how anyone could think option #3 or “eh, it’s just a job” unless they have no experience with the profession or with the dying.
I could never do this work, and I think one needs to have a special calling for it.
That’s exactly how I feel, too. To be around so much suffering (from the dying and their loved ones) and to bring a measure of comfort where they can is a real charism.
Unless you’ve been the sole caretaker for someone who’s dealt a really really shitty hospice nurse. So shitty that you throw them out of the house, and then throw their bag out on the sidewalk after them. Screaming all the while.
It happens. I did it.
She was so goddamn anxious for him to just hurry up and die already, that every symptom meant organ failure and death. No, you dumbass incompetent, he’s allergic to the treatment you’ve given him for dry eyes. And the failure to urinate was a simple UTI, and you sat there and told him that was it, he was going to die within the day.
I threw her out. Called an ambulance. They cathed him and put him on antibiotics for the UTI.
Beware the bullshit “for profit” hospices, and the fools they hire.
Hmm… palliative care doctor would be smack dab in the middle of “impressiveness” (though I wouldn’t necessarily equate that to “failing into” just that certain medical professions carry a lot more general respect or admiration)
A rather incomplete list in order of most impressive to least impressive might look something like:
Neurosurgeon
Endocrinologist
Cardiologist
Pediatrician
Primary Care Physician
Palliative Care Physician
Dermatologist (ok so they help diagnose and cure skin cancer but come on, otherwise it’s all acne and scars and skin peels and wart removal)
Podiatrist (seriously, come on, how is this even a valid field of medicine?)
But I think that anyone should follow their passion and that you don’t fail into one field of medicine or the other, you just find your best fit. But no, Palliative Care Physician isn’t going to garner an automatic level of respect and admiration as being able to tell people you are a neurosurgeon would.
Now I finally understand why people were saying it was depressing. Thank you. I thought they thought it was depressing that you couldn’t figure out what was wrong with the patient.
If the OP really means end-of-life care, then #2 is definitely where I’d go. I’d never think you just fell into it. No one would do that if they weren’t called to it. I can’t really get over the depressing aspects to feel #1, and I tend not to say things I don’t feel., even if they are technically correct.