 | Jerry Old MD is chief consulting medical officer with Hospice Care of Kansas and an associate professor at the University of Kansas School of Medicine-Wichita. He is a nationally recognized author and speaker on end-of-life issues. You may contact Dr. Old by phone at 1-800-HOSPICE. |
Hospice
2009-11-01 15:55:00
Moving from curative care to comfort care
Question: Is there a time when physicians should move from curative treatment to comfort care for their patients?
Answer: After practicing medicine for over 30 years, I have made some discoveries—one of which is that caring for people approaching the end of their lives is very rewarding. I am convinced that there is no other area of medicine where there is so much need and so much potential to touch a patient’s very existence.
As the newest medical specialty, Hospice and Palliative Medicine is not well understood by the public or the medical profession. Death is an uncomfortable topic in our society.
However, good end-of-life medical care is something modern medicine must provide. After all, modern medicine is often part of the problem. By curing many of the acute ailments, we have created chronic disease. With all the possible therapies available today, the dying process has become more complex, and takes longer than it did a century ago when infectious diseases were rampant.
People are now living an average of 30 months after they receive a terminal diagnosis. In addition to the human impact, there is also a huge economic impact. By some estimates, the average patient will spend 75% of the entire healthcare dollars they have spent during their entire lifetime, during those last thirty months.
Physicians must treat suffering as well as disease. Sometimes while treating the disease with modern technology, we become a source of the suffering itself. It is often so much easier for us to simply keep pursuing an unlikely cure, than to have that difficult conversation with the patient and their family about allowing a “natural death.” The wise healthcare provider knows when to transition from cure to palliation.
As we celebrate National Hospice Month in November, knowing when to stop aggressive therapies and embrace symptom management, as well as end-of-life education and support, is the noblest thing that medicine can do. If we continue to treat only disease, we will always ultimately fail; if we treat the person, everyone wins.
