Skip to main content

5 Misconceptions About Palliative Care

Richard Besdine, MD medical officer for the American Federation for Aging Research, has a terrific piece in the Huffington Post about palliative care and misconceptions about the field.  This is GeriPal to the core.  Please follow this link to read the full version.

As a tantalizing preview, here are the 5 misconceptions in brief:
  1. If you accept palliative care, you must stop treatment.
  2. Palliative care is the same as hospice.
  3. Electing palliative care means you are giving up.
  4. Palliative care shortens life expectancy.
  5. There isn't need for palliative care because my doctor will address pain anyway.
Sound familiar?

by: Alex Smith @alexsmithMD

Comments

gercare6@hotmail.com said…
Thank-you very much for Dr.Besdine's piece in the Huffington Post. Now, can we please inform the American public about Palliative Care in fewer years than the too many it took to inform them about Hospice Care. Steve G. Doncevic
Anonymous said…
If the federal and state governments would use the provisions of the 1991 Patient Self Determination Act (PSDA) to mandate informed consent for BOTH and/or EITHER Curative Care or Palliative Care/Hospice transition at EOL, the American public would be better served.

But the AMA didn't want to be put under the provisions of the PSDA in 1991 and have the legal obligation to SEEK informed consent for one of two legal standards of care approved for reimbursement by Medicare. Overtreatment for profit then became possible when physicians did not have the legal obligation to inform patients about the other legal standard of care reibursed by Medicare.

Obviously, palliative care and hospice is a cheaper standard of care to deliver but it provides less profit for the specialist physicians who often provide non-beneficial curative care that may or may not be reimbursed by Medicare under existing reimbursement protocols.

Such a mandate for informed consent would perhaps stop the epidemic of unilateral/defult DNRs that are a reaction to refusal to reimburse by CMS and the private insurers who deliver or supplement Medicare for profit.

Shouldn't geriatric physicians blow the whistle on behalf of geriatric patients?
James Sinclair said…
While the 5th reason makes sense we all know it is not going to happen. Disease modifying physicians have no time to palliate disease. I find reason 1-4 troublesome because they all center around fear and fear of death in particular. If palliative care is designed to allow or even promote that fear we are in big trouble!

Popular posts from this blog

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …

Dying without Dialysis

There is a terrific article in this weeks Journal of Pain and Symptom Management by Fliss Murtagh of King's College in London about the epidemiology of symptoms for patients with advanced renal failure who die without dialysis.  This study is important because while we know that patients with advanced renal failure have a limited life expectancy and the average age of initiation of hemodialysis is increasing, we know little about the alternatives to hemodialysis.  Specifically, we know nothing about symptoms affecting quality of life among patients who elect not to start dialysis (so called "conservative management" - is this the best label?).  This article provides a terrific counterpoint to the article in last years NEJM showing that nursing home residents who initiated hemodialysis tended to die and decline in function (see GeriPal write up here). 

The study authors followed patients with the most advanced form of chronic kidney disease (the new name for renal failu…

Survival from severe sepsis: The infection is cured but all is not well

Severe sepsis is a syndrome marked by a severe infection that results in the failure of at least one major organ system: For example, pneumonia complicated by kidney failure. It is the most common non-cardiac cause of critical illness and is associated with a high mortality rate.

But what happens to those who survive their hospitalization for severe sepsis? An important study published in JAMA from Iwashyna and colleagues provides answers and tells us all is not well. When the patient leaves the hospital, the infection may be cured, but the patient and family will need to contend with a host of major new functional and cognitive deficits.

Iwashyna examined disability and cognitive outcomes among 516 survivors of severe sepsis. These subjects were Medicare enrollees who were participants in the Health and Retirement Study. The average age of patients was 77 years.

When interviewed after discharge, most survivors were left with major new deficits in their ability to live independently. …