Palliative Care

Palliative care is medical specialty/approach to medical care that 

• includes more than just end of life care!!!

• serves patients with serious illness who could benefit from additional support

• can be administered to any patient, no matter their illness stage, prognosis, or intended treatment plan.  (This is in contrast to hospice, with which palliative care is often confused.)

• focuses on the “whole person”--their physical, mental, emotional, and spiritual aspects, as well as the family and community systems they’re embedded in

• aims to optimize quality of life, maximize functionality, relieve suffering, and restore a sense of control in the face of challenging medical realities 

• consists of 

  • • management of distressing symptoms using medicines and non-medicine interventions (e.g. pain, nausea, shortness of breath, difficulty sleeping, constipation, appetite changes, emotional distress, etc.) 

    • guidance and advocacy in medical decision-making to ensure that the medical care received by the patient supports their goals and preferences for their life 

    • emotional support, including “sounding board”-style listening and reframing to help make sense of the medical experience, reliable presence and attention, and a readiness to “walk the path” alongside patients and their loved ones, no matter how emotionally difficult the experience becomes

• extends support to the patient's caregivers and loved ones, and to fellow healthcare providers on the patient's care team

• typically relies on an interdisciplinary team of healthcare professionals—doctors, nurses, chaplains, social workers--although these alliances are not yet formalized in my private practice

What palliative care looks like with me--the philosophical:

• I'll work in concert with your other doctors to make sure you, the whole person, not just the disease, is well taken care of 

• I'll listen, guide, support, educate, and coordinate, according to your needs, and I'll work to help you feel better, physically, emotionally, mentally, and spiritually 

• I'm steadfastly committed to upholding my professional ethics but otherwise unburdened by institutional agendas and therefore free to create truly bespoke therapeutic relationships with you and the important people in your life

• As a board-certified internist, board-certified hospice and palliative medicine doctor, and psychotherapist-in-training, I bring 

  1. • • • specialty-level medical expertise in the management of distressing symptoms (including expertise in the use of opioids)

         • extensive experience (10+ years) caring for adults with complex medical needs at every stage of illness, from initial diagnosis to end-of-life, all of which I bring to bear on your unique illness journey 

         • powerfully therapeutic presence and attention that is unhurried, undistracted, and informed by extensive personal psychotherapeutic work

What palliative care looks like with me--the practical:

• 1. • I offer home visits, office visits, and telehealth appointments, ranging in duration from 10 minutes to several hours, according to your needs, and occurring as frequently as is needed--usually once every several weeks, but up to multiple times per week in certain circumstances 

       • • We decide together on the duration and frequency of appointments

     • I am considered an out-of-network provider, and my fee is $300 per hour, although reduced fees are possible

       • • Many patients paying out of pocket seek retroactive reimbursement from their insurance companies for out-of-network services, and I'm happy to furnish paperwork in support of this practice

• No referrals are required to book appointments with me, however I request that you have a primary care physician or specialist as part of your care team whose role is to manage the illness itself and/or to investigate the symptoms that don't yet have an explanation.  My focus is on you, the person who has the disease, not on the disease itself, so my practice is not set up for diagnostic testing and management of the illness, per se. 

• Before the first appointment, I'll ask you to sign some standard agreement forms and, if able, fill out a written/typed intake questionnaire exploring current symptoms and issues, past medical history, and details about your life and self

• Our appointments might look any of several ways

  1. • • • maybe you're experiencing a particular symptom or issue, and, just like in a typical doctor's appointment, you'll describe what you've been experiencing, and I’ll listen to your description and ask clarifying questions, possibly perform a physical exam (if it will answer a question), and by the end of the appointment, offer an assessment of what I think is contributing to the symptom and the medicines/non-medicine interventions we might use to address it  

         • or maybe you're weighing different courses of action–to try X or Y treatment approach, for example–in which case, we'll explore the medical and personal implications of each of course of action and how they fit with your values and preferences to get clarity on which approach is right for you

         • or maybe you've just been offered a treatment plan, and you don't fully understand it; in this case, we'll explore all of your questions, and I'll reach out to your other doctors, if needed, and work to get clarity until you're comfortable with what's being proposed

         • or maybe you need to vent about how frustrating it is to navigate the healthcare system or how exhausting it’s been to feel sick or how devastating it was to break the news of your diagnosis to your kids–whatever comes up–and I will be there with you, ready to listen and absorb, hold and contain; or just "be," together 

         • or maybe your spouse or child or caregiver or friend needs such an appointment.  I'm here for them, too.

         • we may also organize group appointments called "family meetings" in which the key people in your personal life meet with the various providers taking care of you to bring everyone up to speed and make collective decisions about the direction of your care; I will coordinate these meetings

         • this list is by no means exhaustive, and I'm ready to engage with whatever unique circumstances come up in our work.  If ever we encounter something I feel unable to help with, I'll let you know and help you find someone who can help you.