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"More Thoughts From Dr. Zail Berry"

Posted on November 30, 2009 by Dr. Zail Berry

What is Palliative Care?

A lot of people hear a formal definition of palliative care and still don't have an understanding of what it is. 

As a doctor who specializes in palliative medicine (the doctoring part of palliative care), I am often asked to explain what I do.

Sometimes palliative medicine can be understood by contrasting it with the "mindset" of the broader practice of medicine in our society.

Medicine as a profession is focused on treating diseases.  The fact that the disease is affecting a particular individual and their life is not the primary consideration; it is the disease that is the focus of care.  While many people involved in medical education are trying to change this, the dominant culture of medicine is very much focused on treating disease, not people. 

Palliative medicine, on the other hand, is the medical specialty that turns that around, and looks at the disease through the patient's experience.  The palliative medicine physician asks, "How can we help this person live as well as possible?  How can we make him more comfortable physically?  How can we keep him as active as possible and functioning as close to normally as they can?  What can we do to help him deal with the emotional impact of his disease?  How can we help maximize his coping skills and maintain or improve important relationships despite the illness?  What can we do to support this person to feel as "whole" as possible, despite what he is going through?"

I certainly would like to see a palliative approach throughout all of medicine.  But the palliative medicine perspective is most important in situations where a person has a serious, potentially life-threatening, illness.  There, we confront the possibility that this person may be in the last chapter of his life, and every day is very precious.  It becomes so important that every day be as good as it can be, in as meaningful a way as possible for that individual.  A day wasted by pain or nausea or exhaustion is never a good thing, but when days are so precious, a day wasted is a huge loss.

In most cases of serious illness, palliative medicine is best used in concert with the traditional, "disease-oriented" approach.  In doing so, the patient's perspective is brought into the question of how best to treat disease.  What are the treatment options, and what are the pros and cons of each option in terms of the experience of the patient, now and in the future?  What are the patient's goals and values?  What is most important to him at this point in time?  Which treatment path would best maximize what is most important? 

Some examples of things that might be considerations for many people in decision making about treatment plans are valuing the tradeoff between length of life and comfort, avoiding pain, nausea, or prolonged hospitalization, and wanting to see a personal or family milestone. 

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