Blog

Armed with the belief that as our population ages there will be a continued and growing need for palliative medicine physicians, there is concern that fellowship programs will not be able to keep up.  An article in the Journal of Pain and Symptom Management (one of the main palliative medicine journals)  tries to quantify theRead more

I have long thought that a future economist will look back and conclude that one of the principal drivers of the explosion in US health care expenditures was the misguided decision to dramatically cut provider reimbursements for office visits.  The result was greater remuneration for physicians who performed procedures and operations.  This shift really impactedRead more

I attended an educational program in our community a few weeks ago.  An interdisciplinary group of providers including pulmonologists, respiratory therapists, oncologists, thoracic surgeons, and radiation oncologists discussed a whole host of issues surrounding lung cancer.   The final talk of the program concerned treatment options. Treatment was broken down into that specific for different typesRead more

First off, thank you for being here.  You do cutting edge research and help advance care for all patients.  And in many parts of our country, you are the last refuge for patients who have run out of options. For these same reasons, you also can make my job as a palliative medicine provider more difficult.  TheRead more

To follow along with the theme of my last post, the current opioid crisis- where today 10’s of 1000’s of people are dying each year from opioid related drug overdoses is another example.  Regulations meant to ‘mean well’ have gone horribly awry.  And now, legislators are at it again. a little background history In theRead more

The most recent kerfuffle surrounding abortion rights illustrates the dangers of trying to legislate complex medical issues.  And is particularly distressing. Virginia House Delegate Kathy Tran introduced a bill to remove unnecessary and burdensome requirements surrounding abortion services in her state.  This video, now shown over and over and over again, shows her responding toRead more

In my last post I introduced you to Mrs K and explained how she found herself undergoing ‘rehab’ while she was nearing the end of her life. Her experience is also provides another important lesson.  In today’s health care environment, quality measures are prominent in shaping treatment decisions.  ‘Place of death’ is becoming one suchRead more

This article in the NYTimes caught my eye:  “Costly rehab for the dying is on the rise at nursing homes, a study says”.   The author uses the results of a recently published study  to imply that patients nearing end of life are increasingly being directed to costly and burdensome rehab services instead of focusing onRead more

One of the most challenging conversations providers can have with patients/families, revolves around making decisions when none of the options are particularly good.  And when the patient/family says:  “we will do whatever the doctor thinks is best”– that is a challenge. How does that jive with ‘shared decision making’? And how can a doctor even determineRead more

Palliative care support is not just for patients with incurable disease.  But too many providers, patients, and the general population conflate a referral to palliative medicine with impending death. And because of this, patients are often not referred to us until or unless they are imminently dying. This frustrates the palliative medicine community because ofRead more