The future of palliative care
By Tony Back
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The future of palliative care - Issue #31
I'm in Chicago at the American Society of Clinical Oncology--the meeting opened yesterday with a patient story by a fellow, Edmond Ang MBBCh (video here; start at 8.38) describing his time as 'chemoboy', when attending had dressed him down in front of the ent…
The future of palliative care - Issue #30
Emotion, for many clinicians working with dying patients, has been a third rail. We wag our fingers at the irrationality of decisions people make when they are near death, and often, we assume that emotions are the 'problem.' But in his new book--the culminat…
The future of palliative care - Issue #29
Thomas Lee, writing in JAMA, notes that "trust is increasingly understood to be at risk and in need of attention." I'd say: we're having a trust crisis. And watching Michael Cohen taught me something that i think applies directly to medical care. Let me step …
The future of palliative care - Issue #28
Vincent Harding, a historian of the civil rights movement, looked back at the civil rights movement, and the current talk of 'failure' like this: "[Harding] saw it not as some clearly defined and unique moment of history, but rather as another chapter in a se…
The future of palliative care - Issue #27
A fascinating empirical report on political views
The future of palliative care - Issue #26
Seattle Arts & Lectures presented Pete Souza last night, and his new book Shade: A Tale of Two Presidents. It made me a little teary, honestly. And I wasn't the only one. There were 2500 people packing symphony hall for a *book* event. What sticks with me…
The future of palliative care - Issue #25
One of the most perplexing phenomena about the current political discourse is about the use of information. As Judd Legum, the founder of ThinkProgress, put it in his newsletter Popular Information: "Trump isn't interested in the facts. He's interested in shi…
The future of palliative care - Issue #24
In a new blog in Health Affairs, Shannon Brownlee, author of Overtreated, writes about the problem of getting physicians to stop recommending treatments after negative evidence emerges. "Even when new evidence is clearly negative, clinicians often resist aban…
The future of palliative care - Issue #23
The new Kaiser Family Foundation report on Employer Health Benefits shows a notable data trend: deductibles are skyrocketing. As Dylan Scott put it in Vox: "Just a decade ago, the average American with employer-sponsored coverage had a deductible of $303. Fla…
The future of palliative care - Issue #22
We clinicians know what 'comfort care' means: most often it's an order set intended for a patient who is immanently dying. But as a family member points out a commentary in JAMA Internal Medicine, "Don't you think he [her father, who is dying] looks comfortab…
The future of palliative care - Issue #21
The fact that incentives for patients bear little relationship to incentives for providers is so obviously a fact of life that i've never given it any thought. But as Navathe et al point out in JAMA, from the perspective of incentive design, what patients and…
The future of palliative care - Issue #20
What the public learned from John McCain and Aretha Franklin about how to orchestrate a funeral was nothing short of remarkable. McCain, in his orchestration of his funeral (the Russian pallbearer who had survived poisoning, the visuals of Trump going to play…
The future of palliative care - Summer reading!
The poet Donald Hall is no stranger to loss--he cared for his wife, the poet Jane Kenyon, who died in 1995 of leukemia at 47 (which he talked about on This American Life; she came to Seattle for a transplant). Now he writes about a completely different kind o…
The future of palliative care - Issue #18
In JAMA, Joan Teno gives us a report card on end of life care that can function as a kind of Rorschach test for change-makers: there's the good (deaths in the hospital have decreased from about 50% 30 years ago to 19%); and the not-so-good (deaths in the ICU …
The future of palliative care - Issue #17
If you spend more on medical care at the end of life, shouldn't get more? Well no, not if you live in the US. Spending varies widely, but outcomes don't. Why would that be? In Health Affairs, Keating et al make an interesting observation: "Physicians in highe…
The future of palliative care - Issue #16
As more vertical consolidation occurs in healthcare--for example Humana is buying the division of Kindred involved in hospice--the legal system is starting to recognize the network effects of these relationships. A recent case in Massachusetts allows a family…
The future of palliative care - Issue #15
Charles Ornstein of ProPublica & Mike Hixenbaugh of the Houston Chronicle detail a story not often heard in the media: what happens when a high-risk, high-reward procedure like a heart transplant goes bad. What they're chasing is an investigation of St. L…
The future of palliative care - Issue #14
A 2-year, mixed-methods interventional study in 10 US hospitals targeted 5 domains of organizational culture: (1) learning environment, (2) senior management support, (3) psychological safety, (4) commitment to the organisation and (5) time for improvement. S…
The future of palliative care - Issue #13
A beautifully designed and implemented stepped wedge randomized trial in 5 ICUs at the University of Pittsburgh led by Doug White shows that nurses can be trained in specific roles around family conferences--specifically, to prepare families before a conferen…
The future of palliative care - Issue #12
Michael Pollan, well known for his insightful food journalism, got interested in psychedelics when he heard a psychologist talk about microdosing at a Berkeley dinner party. His newest book, How to Change Your Mind, traces the lively history of LSD & psil…