Page 17 - Boca Club News - November '23

Boca Club News, Page 17
Medical Matters: Palliative Care

By Richard Nagler, M.D., a member Palliative care is a team approach offered at any age options for years, even to also prolong life. Some patients
of Broken Sound Club and retired in homes, hospitals, nursing homes or clinics involving may recover, depending on the illness and prognosis.
physician. After graduating from doctors, nurses, counselors, social workers, pharmacists, In contrast, Hospice can begin only when the illness
the University of Pennsylvania physical therapists, nutritionists and volunteers. All work is terminal, no cure is possible, and all medical therapy
and New York University’s School together with the patient, family and other doctors to must be discontinued with the patient having fewer than
of Medicine, Dr. Nagler served complement ongoing specific medical treatment. It does six months to live. Here the patient or family decides that
his internship and residency at not depend on the stage of the illness and continues while no further efforts to prolong life will be implemented. Both
Baltimore City Hospital and Johns the patient is receiving ongoing treatment designed to cure palliative care and Hospice are covered by Medicare and
Hopkins. He followed that with a a health problem or prolong life. Medicaid.
Fellowship in Gastroenterology at Yale University School The most common diseases involved with palliative Because of the remarkable technological advances in
of Medicine, and was then Chief of Gastroenterology care are metastatic cancer—including the side effects of both diagnosis and treatment for patients with chronic
at Fitzimmons General Army Hospital in Denver. He chemotherapy and radiation—dementia, congestive heart serious life-threatening illnesses, not only are some of
returned to the Yale Medical School for one year as an failure, AIDS, Parkinson’s, kidney failure with dialysis, them cured, but they may live into their 80s and 90s.
Assistant Professor of Medicine before opening his own and debilitating strokes. They address such issues as pain, However, there remains considerable suffering from
successful private practice in Internal Medicine and shortness of breath, anxiety, fatigue, nausea and vomiting, the symptoms of these diseases and the side effects of
Gastroenterology. During that time, he also served for loss of appetite, and depression. It helps the family cope treatment. It is more important that we recognize the
ten years as Chief of Medicine at Huntington Hospital in with the death of a loved one, address financial concerns, need for compassionate care to be an integral part of the
Huntington, N.Y. guidance on how to connect with community resources, overall approach to the patient. That involves establishing
In response to the need for addressing and caring of end- breathing techniques, listening to music, and advanced a trusting doctor-patient relationship. Palliative care and
of-life issues and chronic life-threatening illness, there is a care planning regarding goals and wishes. It offers help Hospice both serve that function very well, not only for
relatively new medical subspecialty called palliative care. It with a living will and a health care power of attorney. better outcomes but for the relief of needless pain and
is approved by the American Board of Medical Specialties Palliative care reduces unnecessary hospitalizations suffering and a far better quality of life.
and the American Board of Internal Medicine. Certification and overuse of health services. It provides a greater
requires previous residency training and Board certification understanding of the value of opiates in effective relief
of three or more years in other medical disciplines, including of intolerable pain, as well as the removal of restrictions
internal medicine, family medicine, surgery, emergency denying access and allaying concerns about addiction
medicine, ob-gyn and pediatrics. This is followed by a under these circumstances.
one-year fellowship in a palliative care program. There are, however, problems with obtaining access to
Currently, there are only approximately 8,000 board- palliative care. Our national health policy systems don’t
certified palliative care physicians in the United States, yet include palliative care, and training for palliative care
despite the fact it is estimated that more than 10 million physician specialists is limited or not available throughout
people in this country would benefit from palliative care. the country. Moreover, there is a lack of awareness of what
Ideally, palliative care should begin early after the onset of palliative care is about, not only on the part of patients
a chronically serious life-threatening illness. In contrast to but among policy-making health professionals, and there
Hospice, it is specifically designed to complement normal remains misconceptions and confusion between palliative
curative medical treatment by treating the patient not just care and Hospice. Also, there are cultural and religious
the disease, concentrating on preventing and alleviating barriers regarding beliefs about death and dying that persist
pain and suffering, especially from both the symptoms and in our society.
side effects of the disease, and medical treatment with the Palliative care shares some similarities with Hospice,
goal of improving quality of life. In addition, palliative but there are very specific and important differences.
care provides emotional support for both the patient and Palliative care can, and should, begin when the diagnosis
family and helps them to understand the ramifications of of a serious life-threatening illness is made–and then
an illness and make decisions about treatment options. continue to complement medical curative treatment

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