Wednesday, August 26, 2009

Educating the masses about Geriatrics and Palliative Care (aka Marketing)

Geriatrics and Palliative Care (and primary care) have a problem. We haven't learned how to make our work, our mission, "sexy."

During yesterday's White House Health Reform open conference call with physicians (reportedly 2700 physicians connected to the call) http://www.healthreform.gov/, an astute participant asked why the White House health reform committee doesn't hold public education campaigns about end-of-life care to debunk the highly skewed Death Panel myth. The Health Reform representative moderating the call said that was a fabulous idea and that she'd bring it to the attention of the White House, but also encouraged physicians to do their own education and outreach campaigns locally.

As has been noted on GeriPal in other posts and comments, we in geriatrics and palliative care are not the most savvy marketers. The fact that the forces behind the Death Panel--the money, marketing, personalities--can so easily create such a phenomenal stir on the public's emotions is a testament to how much more effective other entities are in marketing their beliefs (even with little/nothing to back them up). Our problem, in geriatrics and palliative care, is that we are globally poor at PR. Organizations for breast cancer, HIV, leukemia and lymphoma--even colon cancer screening with the endorsement of Katie Couric--have promoted their work and mission so effectively that you can't open a magazine, walk down a town square, or attend a local 5k or marathon without seeing them represented in an ad, lamppost flag, or banner. To me, the irony is that our aging population carries a significant proportion of the burden of each of these conditions, not to mention the chronic illness or functional debility that they may have at baseline or develop because of the more highly 'marketed' conditions.

The lack of education and awareness that the public has about geriatrics and palliative care was made evident to me yesterday morning when I received a call from the daughter of one of my housecalls patients. My 92 yo patient has a colonic tumor and advanced COPD requiring 24hr oxygen. The day prior, during an episode of shortness of breath, she panicked and hit her Lifeline button (which she has because of her frequent falls). An ambulance was called and when they arrived and learned she was on hospice they immediately, appropriately, called the hospice 24hr phone line. She was instructed by hospice to take a dose of her morphine which immediately relieved her shortness of breath and enabled her to relax and breathe more comfortably. Her daughter called me upset because as one of the ambulance personnel left, he commented to her, " I don't know why they told her to take morphine. That's contraindicated with COPD." I acknowledge that I don't know who this ambulance staffmember was and whether he was at all medically trained, but regardless, his comment--ill-timed, and ill-informed--caused my patient and her daughter significant distress. The hospice nurse and I both spent time talking to my patient and daughter to reassure them of the indications for using morphine to relieve suffering, and also to explain that, unfortunately, even ambulance personnel do not always understand hospice care and palliative medicine.

If our frontline health care staff (such as EMTs) have no understanding of palliative medicine [and further, by something as simple as a misplaced comment--made while wearing their official medical uniform and carrying a nametag and stethoscope--are able to raise fear], how are we to expect the public to understand the work we do in geriatrics and palliative care? But beyond simply educating all health care practitioners about palliative care, we have a responsibility to also educate the public.

4 comments:

Umanohone said...

Your article reminded me of this recent article in Geriatrics on Palliative Interventions: A review of interventions to improve palliation of pain, dyspnea, and depression.

They start off with a woman who has terminal COPD and worsening dyspnea.

Your post brings up the great question of how do EMTs get taught about terminal illness, symptom management, DNR/DNI orders, etc. I honestly don't know.

-Chrissy Kistler

Patrice Villars said...

I had a hospice patient tell me once that his ambulance attendant told him he 'refused' to follow a DNR order, that it was contrary to the responsibilities of his job. This experience confused and upset the patient for a good two weeks. I agree that we need to get better at marketing, not just educating those already interested.

ken covinsky said...

Helen---thanks for that very thoughtful post. It is really easy to get upset at all the demogogary about advance illness planning. A lot of the discussion is an insult to patients and families that struggle with these issues.

But Helen is right that is not enough for us to just get angry. We need to think about why it was so easy to manipulate this issue, and the role we all have in explaining these issues to the public.

For example, why did this get portrayed as having anything to do with denying care? Advance care planning is an affirmative act. It is a statement that every day of life is of value, even the last days. Advance care planning is one of the ways we can try to right by patients when they are most vulnerable.

Palliative medicine and Geriatrics are very much about the sanctity of life. The hospice movement in part grew out of failures to value the last days of life as much as the first ones. Similarly, Geriatrics, in part, grew out of the failure of Medicine to care for chronically ill and frail patients whose underlying diagnoses are not curable.

Providers in these specialties never stop caring for the patient, even when cure is no longer possible. These specialties do not know the patient for whom there is nothing more to do.

Maybe we need to stop being so technical and academic, and "wear our values on our sleeves."

Anonymous said...

Keep posting stuff like this i really like it