Improving Life as It Ebbs

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What’s the biggest misconception people have about hospice and palliative care? People assume that hospice and palliative care are the same. Hospice is interdisciplinary end-of-life care provided during the last six months of life. Palliative care is interdisciplinary care to improve quality of life that can begin right at diagnosis. It is not limited to end-of-life care. Many miss out on palliative care because of this. In fact, most of what I do is improving quality of life through symptom management.

Why did you choose this specialty? I chose it because I love people’s stories. I get to know them as a person and find out what quality of life means to each person. They tell me what is important and who is important.

What are your areas of special interest and what is it about them that is most interesting to you? My area of special interest is the introduction to palliative care very early in the disease trajectory through a process of automated triggers. These allow the patient to have access to palliative care early on, with each referring provider thinking of who qualifies for this extra layer of support during a very busy clinic visit. For example, all patients who are diagnosed with pancreatic cancer can receive palliative care. Swedish has been piloting this, and we are hoping to improve care for patients throughout their illness.

Is there a patient behavior that you wish you could change? I wish patients and families would advocate for their own quality-of-life issues while receiving disease-targeted therapy. We want to keep in mind that advocacy does not need to be hostile or aggressive. Great advocates engender the support of the health care team when they ask thoughtful questions seeking information, rather than [making] demands and complaints.

Is health care reform affecting how you practice?  The hope is that palliative care will be part of the solution in health care reform. It is a low-cost, low-tech way to improve quality of health care. In fact, palliative care may show higher-quality care while simultaneously lowering cost. It was never good in the fee-for-service world. We don’t see a huge number of patients. We spend quite a bit of time getting to know the person and family.
 
What’s the most fun—outside of medicine—that you’ve had recently?
I love to do runs with my husband and children. My husband and I have a friendly competition running 5K/10Ks, and the kids do fun runs. We also love to travel, and we went on an Alaskan cruise with our extended family last summer.

What qualities should a patient look for when choosing a doctor?
A patient should pay attention to how much a doctor listens rather than how many facts that they can recite. There is a better chance of shared decision-making and receiving care aligned with your values, goals and preferences if a doctor listens to the patient.