Thursday, September 22, 2016

Tumor Board

The Nightingale: Hey! I'd like you to meet palliative care doc. She's going to talk to us today a little bit about what she does.

Me: Nice to meet you! I've seen your name in the charts. I'm a pathologist. I love the idea of being a palliative care doc - always wanted to.

The Nightingale: You should do it!

Me: But I love pathology too . . .

Palliative Care Doc: You can come on rounds with me sometime if you want.

Me: I would love that.

The Nightingale: Ok everyone let's start. I've got someone to introduce you to. She's going to talk about palliative care. I've used her a few times and she is excellent. Not just for hospice, also for inpatient pain, depression, and dementia.

Palliative care doc gives a short spiel about who she is, where she is from, where she is located, where she trained.

Swagger and Sagacity: So tell me this. The hospitals have a reputation for sending nurses and social workers to my patients and talking them into getting hospice consults. Then they end up taking over my patient, who I have a long relationship with.  Sometimes years. Just because my patient is in a pain or  depression crisis - because hello, they have CANCER - they in no way need a hospice consult, but they and their family are easily convinced they do and it becomes such a mess for me to clean up.

The Owl: That happens to me too. Makes me so angry. I call them. I yell at them! I yelled at a hospitalist the other day who did that very thing. If you yell enough maybe they will learn.

The Nightingale: This doesn't happen when you consult her. I've only had good experience, and she stays in close communication with me about the patient and the decision making process. But I know what you mean. Believe me. A cancer patient in pain crisis is the perfect set up to be duped into thinking this is the end. This is why we are so important. We are in charge, at this moment. We know the patients better than anyone in the hospital and we are trained to know the disease process more than the patient or their family. Everyone needs to listen to us. I think it's good that she is here, she will help to turn around this problem. Educate and care for our patients with us. See? It's good to have these conversations. We all learn why there is such a stigma around consulting hospice and how trained individuals are part of our team, not working against us. I'm really glad you came. Ok, let's move on to the patients. Who wants to go first?

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