Monday, January 26, 2009
Today marks the end of an international symposium at San Diego Hospice that's focused on keeping people comfortable as they die. Doctors who practice palliative medicine aren't trying to cure people. But they say their brand of medicine saves money and it makes a lot more sense than letting people die in hospitals. KPBS health reporter Tom Fudge has more.
Do no go gentle into that good night. That was the advice of poet Dylan Thomas to those who faced death. And it might be the motto of American medicine. The goal of fighting disease is embodied by hospitals with their acute care beds, emergency rooms and trauma centers.
But doctors who practice palliative care say we may need to look at the end of life in a different way. Frank Ferris is director of the International Program at San Diego Hospice.
Ferris: "As patients approach the end of their lives, 50 percent of the people dying in America die in hospitals. 50 percent of the people who die in hospitals, have at least a few days in an intensive care unit during that last stay in the hospital. That's very expensive therapy."
Expensive… and not what a lot of people really need or want. Ferris says doctors can predict when resuscitation and aggressive care at the end of life is not going to return a frail patient to good health.
Ferris: "When you talk to people honestly about that, many people will say, well then don't treat me that way. Give me this alternative. I would like to be at home. I would like to be with my family. I'd like to have my symptoms controlled. I want to be with my grandkids. I'd like my puppy dog on my bed with me. And let me enjoy the days I have."
The alternative he referred to is palliative care.
Physicians from around the world have gathered in San Diego at a symposium hosted by San Diego Hospice. The physicians here at the conference practice a brand of medicine that is aimed, to a large degree, at controlling pain. This is done through therapies and medications. Palliative care is very often used for patients, dying of chronic, advancing diseases like cancer.
Palliative medicine, when its available and applied, does save money. A study in the Spanish state of Catalonia was cited by one of the conferees. It shows that the use of palliative care reduced ER visit by 50 percent. The length of stay in acute care hospital beds was down by forty percent. The cost of palliative service in Spain is forty percent less than the cost of acute care.
Karl Johan Furst is a physician and a medical professor at Stockholm's Karolinska Institute. He describes a palliative care team.
Furst: "A doctor, a nurse, and typically we also have a social worker, an occupational therapist and a physical therapist. And sometimes there is a chaplain."
He says the process also requires doctors to speak frankly with their patients about death.
Furst: "Be brave enough to talk about reality. And that is not psychological counseling. That's the art of medicine. They help you with a lot of attitude adjustment."
Vicky Powell is a San Diegan whose mother-in-law died of cancer while in the care of San Diego Hospice.
Powell: "I mean it's hard to accept that someone you love is dying of cancer, because they're making progress with cancer every day and there must be something you can do because our mindset is to fight death at every opportunity."
The ability to speak frankly about death, and to accept it, is at the heart of palliative medicine. Xavier Gomez-Batiste is director of palliative care programs for the World Health Organization. He says this type of medicine is not a death sentence and patients keep their options open. But he says hope can take many forms.
Batiste: "The window of hope must be never closed. And hope can be converted into the hope of not being alone, not being abandoned, to have a team that will answer your needs at any time. So I think this is a crucial concept."
Tom Fudge, KPBS News.