Orlando Ensuring the Future of Hospice & Palliative Care
BY RYAN CHAPMAN, DO
Hospice and Palliative care are fields of medicine that are often misunderstood by both health care providers and community members alike. This is not surprising given that hospice and palliative care education had been lacking in most medical school curricula. During my first six years of medical education, I only had one week of exposure to hospice (which was embedded within a geriatrics rotation). It wasn’t until my fellowship in Hospice and Palliative medicine that I really learned the differences between hospice and palliative care. We learned how to compassionately discuss resuscitation status, how hospice works and that some cancer patients have been shown to live longer when they are seen in conjunction with a palliative care specialist.
The demand for palliative care and hospice services is growing around the country. In the year 2000, less than 25 percent of U.S. hospitals had a palliative care program, compared with 75 percent in 2015. It is predicted that the percentage of patients who require or are eligible for palliative care will continue to increase due to aging population demographics. On the other hand, the hospice and palliative care physician workforce is set to stagnate or even decline, leaving a worrisome shortage. Thankfully, the need for more robust training in palliative care is now being recognized by medical schools throughout the United States.
I would not be where I am today if it were not for the amazing teachers and mentors I’ve had throughout my training and career. That is why I am so excited to now have the opportunity to provide clinical palliative care and hospice education to third and fourth-year medical students at The University of Central Florida. Students will have the opportunity to round in the hospital performing palliative care consults. There, they will be managing cancer-related pain and symptoms, leading family meetings, holding difficult conversations and coordinating the care of medically complicated patients. They will have the opportunity to see hospice patients living at home, as well as see those patients being treated in our inpatient hospice units for acute symptom management. Students will participate in interdisciplinary team meetings, which is an essential part of hospice care. They will be exposed to how important our nurses, chaplains, social workers, therapists are to the care of the patient. We will be able to expose students to the comprehensive care a true hospice team can provide to a patient and their family.
To be given the responsibility to train and guide future generations of doctors on how they approach the care of such a vulnerable population is a privilege I do not take lightly. It is an opportunity to teach students that palliative care can be provided alongside life-prolonging treatments, such as chemotherapy.
Showing students how to systematically assess a patient’s pain and symptoms, teaching students how to manage that patient’s pain, and explaining the importance of listening to a patient’s goals will serve students throughout their career. The opportunity to guide young doctors on how to approach difficult conversations and plan end-of-life care is so very important. These lessons will not only make them more knowledgeable about hospice and palliative care, but it will also make them better doctors.
The reality is that all specialties of medicine, whether surgery, cardiology, or even pediatrics deal with seriously ill patients. This means all future doctors should be equipped with the basics of delivering bad news, assessing goals of care, and recognizing when aggressive or invasive treatments may be causing more harm than good. Sometimes we do not know the right words to say. Sometimes we do not know the right decisions to make. By training future doctors in the fundamentals of palliative care, we will help them strengthen the patient-physician relationship, ensure fewer patients suffer, and provide better satisfaction and quality of life to our patients and their families.
Ryan Chapman, DO, received his medical degree from Nova Southeastern College of Osteopathic Medicine in Ft. Lauderdale, Florida. He completed specialty and sub-specialty training at Jackson Memorial Hospital and the University of Miami. He is dual board-certified in both Internal Medicine as well as Hospice and Palliative Medicine. He serves as a hospice and palliative care physician for St. Francis Reflections Lifestage Care in Brevard County.
