Resident Physicians

Welcome!

Our expectation is that you are a motivated learner who will take advantage of the opportunities and resources available to you over the next few weeks to educate yourself in the art and science of hospice and palliative care. These opportunities and resources include our patients/families/caregivers, nursing/social work/chaplain staff, physicians, various electronic and print media.

We will sit down on the first day of service and discuss your goals for the rotation. Based on these, we will outline a plan of study for the time you’re here with us. Your core clinical responsibility will involve daily rounds at our inpatient unit.

We’ll sit down as often as possible to talk about questions you might have as well as current cases. In addition, we’ll set aside specific times to discuss the basics of hospice and palliative care.

Getting Started

Please email me your cell phone #, goals for the rotation, and any calendar events during your rotation (clinics, absences, vacations).

It is important to read up on basics of pain and symptom management … Hallenbeck’s book (ch 4 & 5 on Pain and Non-Pain Symptom Mgmt) or UpToDate – e.g. Cancer pain management with opioids: Optimizing analgesia especially the section Practical Considerations in Opioid Use … as well as other sections in UpToDate.

Review the Hospice Inpatient Unit Admission orders (download) (link) … it is important to be familiar with these.

Instructions for documentation & dictation are just below (scroll down a little).

Familiarize yourself with the “8 Domains of Hospice and Palliative Care” (scroll down) … This will get you introduced to our “way of thinking” and approaching the patient and family.

Reading Assignments …

The reading assignments from the Hallenbeck Palliative Care Perspectives text (online edition) are …

Intro … 1,2,3
Pain … 4
Non-Pain Symptoms … 5
Psycho-Social-Spiritual … 7
Communication … 8
End-of-Life Care … 6, 11

Art & Literature

the film “Red Beard” is on 3-day reserve at Med School library …

suggested sequence …

week 1 – Red Beard; Medical Case (Chekhov)(on google drive)
week 2 – Dekalog 1; The Death of Ivan Ilyich (Tolstoy)
week 3 – Dekalog 2; Wit (and Sulmasy piece)
week 4 – Dekalog 8; Last Farm

Documentation & Dictation Guidelines

Tips from other Residents

Other opportunities include…

Daily rounds at Via Christi – St. Francis Hospice Center
Home visits
Hospital Palliative Care Consults
Referral (initial hospice contact) Visits
Interdisciplinary Team Meetings
Clinical Visit with other members of team – SW, Chaplain, RN, etc.
Paper – research, clinical update, narrative/self –reflection
Presentation at weekly Journal Club

The Physician and Hospice/Palliative Care

The most important factor the physician brings to the clinical encounter is our presence. Presence is the act of being fully engaged – attentive, receptive and responsive – to the patient, family member, caregiver, staff member who is ‘in front’ of you right now.

Our attitude is absolutely fundamental…We bring an attitude of humility, openness and wonder to the process. We are present. We listen. We do not have all the answers.

Humility – Listen to our patients. Listen to our families and caregivers.
Listen to our nurses, social workers, chaplains, health care aids and volunteers. Do what they tell us.

Openness – We cannot control death. Death is a natural process that we shepherd. We set the table for a good death.

Wonder – We work in wonder before a Mystery much greater than we. In humility, openness, and wonder we set the table for a good death, lead the team, and provide our patients, families, caregivers and staff with the resources and tools they need.

Harry Hynes Memorial Hospice

Mission – The mission of Harry Hynes Memorial Hospice is to enable people to live with dignity and hope while coping with loss and terminal illness.

Philosophy of Care – Harry Hynes Memorial Hospice exists in the hope and belief that through appropriate and competent care, patients can approach the end of their lives with dignity and comfort in the midst of a caring community sensitive to their needs.

Touchstones – Safe and Comfortable Dying, Self Determined Life Closure, Effective Grieving

Hope – certainty in the future based on something present now.

Dignity – the esteem and honor human beings deserve simply because they are human.
– we continue to heal by reminding the sick and dying of their essential meaning now.

Theme – set the table for a good death.

Core values – presence, competence, compassion, community, communication, dignity, generosity of spirit, stewards

Presence – the art/act/event of being fully engaged, attentive, receptive and responsive to the patient, family member, caregiver, staff member who is ‘in front’ of you right now.


8 Domains of Hospice & Palliative Care

Structure and Processes of Care – interdisciplinary team assessment based on patient/family goals of care; hospice level of care (inpatient unit, home); d/c planning

Physical Aspects of Care – pain, dyspnea, n/v, fatigue, constipation, other; performance status; medical diagnoses; medications (add/wean/titrate)

Psych Aspects of Care – anxiety, depression, delirium, cognitive impairment; stress, anticipatory grief, coping strategies; pharm/non-pharm rx; pt/fam grief/bereavement;

Social Aspects of Care – family/friend communication/interaction/support; caregiver crisis

Spiritual Aspects of Care – spiritual/religious/existential; hopes/fears; forgiveness;

Cultural Aspects of Care – language, ritual, dietary, other.

Care of the Imminently Dying – presence; recognition and communication to pt/fam; education/normalization; prognosis (eg hours to days; very few days; etc)

Ethical & Legal Aspects of Care – decision maker; adv dir; and/dnr; manh; abx.

These serve as an excellent framework for an approach to the patient/family, documentation, and other communication.