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Palliative Care… What It Is and What It Isn’t
By Dr. Erik Fromme
I work as a palliative care physician on a team with several nurses and several physicians. In the hospital, we do five things:
- We attend to pain and symptom management.
- We try to help patients clarify what their goals are in their care, and sometimes we get the various doctors to give their opinions about the illness and prognosis.
- We try to provide patients with a plan once they leave the hospital so they won’t have to return right away. Our patients are very sick, and often many things can go wrong. We try to think of contingencies and set them up so that if they want to leave the hospital they can, without needing to turn right around and come back.
- We provide psychosocial support, which is really just a fancy word for support. Support to the patient and the family, but also the patient’s health professionals. They are constantly dealing in extremely stressful situations, so we try to be a support to them.
- We provide end of life care for the patients who are dying in the hospital.
How Does Palliative Care Differ from Hospice?
There is a misperception that palliative care is the same as hospice. One patient thought that because her doctor referred her to me, he was trying to tell her she was dying. But that wasn’t the case at all. Palliative care differs from hospice care in that there is not a restriction; I can see patients who aren’t terminally ill or who would like life-prolonging procedures, which is not the case with hospice. I help those patients who don’t qualify or aren’t ready for hospice care.
Understanding Goals
My purpose is to try to find out what my patients’ goals are and to try to support them in those. I do this even if I might have chosen to do things differently or take a different course, because I trust people to know what’s best for them. I don’t ever want to put them or me in the position that they have to choose between what they feel they must do and the care that I can provide.
Regaining Some Control
What makes pain and life-threatening illnesses so terrible is that they can take over everything. What I’ve found is that it’s rare for pain medications to eliminate pain, but they are a tool to work with to change the patient’s experience and get some control back over their lives. I try to help them do that with pain medication, with their decision-making, and with their approach to the illness.
Beyond Pain Medication and Treatment
We’ve developed so many effective treatments, sometimes we forget that the body has its own intrinsic capacity to heal. You don’t need a doctor to heal a cut; the body can handle that on its own. I try to help patients identify things that they can do to support or help activate their bodies own capacity to heal. There are many ways to do that, but it’s very specific to each person. It gets down to some basic questions:
- What gives you strength?
- What makes you feel enlivened?
- What makes you feel replenished or renewed?
- What makes you feel like you’re in the driver’s seat of your life?
The answers are actually pretty consistent. The most common are:
- Spending time in nature
- Exercise
- Gardening
- Doing arts and crafts
- Music
- Meditation
- Spiritual practice
- Complementary and alternative medicine therapies like Reiki, acupuncture, therapeutic touch, and massage
- Spending time with kids
- Spending time with pets
The same activities that can help to keep our minds and bodies healthy can sometimes also be helpful in healing illness. At the very least, they can provide pleasure and even distract from pain.
Dr. Erik Fromme is an Assistant Director for the Center for Ethics in Health Care and an attending physician on the OHSU Palliative Medicine and Comfort Care team, with a special focus on cancer patients and their families. He earned his M.D. at The University of Oklahoma Health Sciences Center, did his residency in Internal Medicine at OHSU, and completed his fellowships at Johns Hopkins University and Massachusetts General Hospital.
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