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Scott Webb (Host):  We all want to be treated with kindness and fairness by healthcare professionals. Quality of life for our loved ones and ourselves is of great concern. We’re joined today by Dr. Jason Reter, a Family Medicine doctor at the CGH Lynn Boulevard Medical Center to discuss palliative care and how it affects quality of life for all patients. Tis is the About Your Health podcast from CGH Medical Center. I’m Scott Webb. So, Dr. Reter, thanks for joining me. I want to have you start today by telling everybody what is palliative care.

Jason Reter, DO (Guest):  Okay so palliative care is kind of a new concept and even a medical specialty but it’s a very old value, kind of as old as medicine and doctoring itself. Palliative care is at its core, taking care of patients and any of their suffering. It can be as simple as taking a pain killer for a headache is officially palliative care, but palliative care as it is talked about today, is more about care for patients with severe or even life threatening or incurable illnesses. We often use palliative care in our most ill patients. It’s used most commonly with our cancer patients. But also with our hospice patients.

Sometimes people get confused about is palliative care and hospice care the same thing. Palliative care treats patients and their problems, their pain, any shortness of breath, any anxiety but they can still receive life saving process. So, they can still be chemotherapy, they can still be in and out of the hospital. Hospice care is dedicated to patients who have decided that they don’t want to continue to pursue aggressive treatments, maybe the treatments are no longer working, it’s become futile. And so now they’re just focused on comfort measures only.

So, palliative care is hospice care, but it’s also care for patients who while have a serious illness are still actively fighting it and are in and out of the hospital.

Host:  Okay, I think I got it. So, how exactly is palliative care provided?

Dr. Reter:  I think at its best, palliative care is provided by the patient’s regular physician team. Hopefully the primary care physician that they’ve been following with, if they are in the hospital; their primary team that’s there. But also, it’s used a lot with again, serious illness are cancer doctors, the oncologists. They are sort of also an important part of palliative care and getting involved. But palliative care is usually a team. It’s not just your doctor, it’s also working together with nursing staff, both in the hospital and home nursing staff, coordinating with social services to make sure that if there’s any medical equipment that needs to be at home, any oxygen, any additional resources for both the patient or the family that that’s available.

Palliative care teams and again, because it’s best thought of as a team approach usually also includes religious or spiritual services that the patients might need. And also being aware of any mental pain and suffering for the patient or the family. So, we like to think of palliative care as yeah, there’s often a leader that initiates it and that’s most often your regular doctor, but also the plan for palliative care is to work as a team to control the symptoms and problems related to the serious illness.

Host:  This is really interesting. And it does seem like a total team approach, starting with the primary, but extends out and it really seems like care for the body, the mind, the soul; really fascinating. And I think I know the answer to this but where exactly do people receive palliative care? Hospital, clinic, home, et cetera.

Dr. Reter:  The short answer is yes all of those places. There are some organizations that have a palliative care specialists where there is a doctor that that’s all they do. Those situations they still sort of partner with whoever the lead physician is that sort of did the referral, but they sort of are taking a more active management. I practice in a small community where we don’t have that resource to have that specific specialty. But we go out of our way in our community and our hospital environment both inpatient and outpatient to kind of enable and educate our staff, our primary care providers to sort of be those leaders.

It can be a palliative care team that’s seeing you in the hospital but then there’s the expectation that once you leave the hospital, that team is going to follow you at home and again, some palliative care plans are initiated on patients that have never been in the hospital but again, are dealing with a serious illness.

Host:  That is great to know that people can come to you, can come to the hospital but also that the treatment can come to them. Here’s the big one doc, does insurance pay for palliative care?

Dr. Reter:  Yes and no. Unfortunately. There are some services that are covered well and some that aren’t and while hospice care which again, that is end of life care for patients with incurable illness that have decided that they want hospice care. Hospice care has been around longer frankly. Hospice care has been going on since really the 70s. That is a more established service and again, these are people that want palliative care, but they also don’t want curative services. That’s very well covered by Medicare and all Medicare, all insurances. Palliative care I think partially because it’s a bit of a new concept, it’s a newer specialty, it’s not always covered and so sometimes we’re doing palliative care but we’re working with home nursing and these other social service networks. We can make it work but the honest answer is it’s not always covered by insurance.

Host:  So, how do I know if palliative care is right for me in my situation?

Dr. Reter:  The time to know not just for like your own situation but most importantly for a family member is if they’re struggling with a diagnosis. If you feel like maybe some of your symptoms whether it be a pain, shortness of breath, the stress of dealing with the overwhelming problems that can occur with a major illness, is sort of too much; that’s the time to ask your doctor is there other resources available. We try to educate our physicians, that’s part of my job working here at our hospital is making sure our doctors are kind of being proactive about this but I’m also always encouraging patients and family members to be proactive with their own doctors and saying is there any other resources or if you are dealing with an ill family member, is there – mom’s really struggling with this or we don’t seem to have her pain under control, is there any other resources that are available.

And then as always, asking questions and making sure you understand your disease process for you and your loved one can help sort of better drive that conversation with the docs.

Host:  Yeah, it seems like what we’re really talking about here is quality of life and trying to make sure that people have the best quality of life regardless of what their situation is or where they are receiving the care. Is that what we can expect from palliative care like a great attention to quality of life?

Dr. Reter:  Yeah, definitely. Palliative care it’s sort of what an old value of medicine should be anyway. I think it’s best practices. I think it’s something that as physicians, I would hope that we’re all focusing on the quality of life of our patients. But I think it arose when there was a need for people with very complex medical problems and maybe even some disagreement with the family members about how to treat an illness that you would have a team that would be sort of available for sort of the most difficult of those patients. But again, at its core, it’s about quality of life and making sure that we’re addressing issues promptly, appropriately and individually for each family. I mean some families decide they or individuals decide they want aggressive treatment no matter what and others decide very early in the process that they don’t want aggressive treatment, they’d rather just focus on comfort measures and it’s kind of our job in healthcare to sort of be able to recognize and manage and provide for all of those options.

It does seem like CGH Medical Center is out in front of this. That there’s an education process here about not only with insurance companies perhaps but also with prospective patients and families. So how does CGH Medical Center provide palliative care?

Dr. Reter:  We’re providing it at an individual level with working with the primary care physicians and the hospitalist teams and our home nursing and social services. So, it is in the hospital, the team is all right there and everybody is communicating with the patient and the family members when it arises. As an outpatient, it is usually a couple of different visits to see home nursing, social service to call in. We sometimes try to get all of those resources in on place if that’s easiest for patients. It’s individualized to the patient and an individual problem. But I think most importantly, what we’re trying to make sure is all of our nurses, our doctors, our nurse practitioners, our specialists understand that it’s an option and it’s a goal for us to make sure that we’re giving the best care. I’ve worked as a Medical Director at a local hospice since 2003 so while I’m an expert, I’m more of a resource to ask other doctors if they have questions. But again, I think having worked here for so long, I think that we do a good job across the board of meeting these needs.

Host:  It definitely sounds like it. So, probably know the answer to this, and I guess it’s as simple as probably just asking for it, but I want to have you explain. If I come in and I want palliative care, or I want it for a family member; how do we get that ball rolling?

Dr. Reter:  Most often, it’s dealing with your lead physician. So, again, hopefully there’s already a primary care doctor that knows well about what’s going on. But again, sometimes it’s initiated by the oncologist, by the cancer doctor or in the hospital. Some of the doctors don’t see their patients in the hospital and then the hospitalist team takes over and that’s the conversation with the lead doctors there. So, it’s really just a matter of recognizing that there’s a need. And asking for it or in general, if you don’t even remember, the words palliative care, if you just say I need some additional help dealing with all of the stresses, is there any other resources available to me. I think that’s always a good way to ask for more help. But asking for palliative care by name certainly will help. And sometimes the answer is, the insurance doesn’t cover it but we’re still going to make sure that there’s home nursing available and there’s social service available. And so, it may not be an official palliative care team that all – but all of those resources that we have available will all be working towards the same goal. And we’ll be talking the language and again, it’s about quality of life. It’s about getting the end result.

Host:  Always comes back to that, the quality of life. And it is a comfort to know that oftentimes patients are going to be dealing with their actual primary doctors or at least doctors that they are familiar with that they are not just automatically being handed off to some other specialist group. So, they’re going to be talking to their doctors, they hopefully know now that they can ask for it and even if they can’t ask for it by name exactly, that at least they know what their end goal is, what they are after and that the folks at CGH and you and everybody else, even if you can’t give them total palliative care, that total team approach; you can give them bits and pieces and work towards that goal of improving their quality of life. Lastly today doctor, anything else as we wrap up to include to make sure that people know about palliative care, what’s involved, how they get it?

Dr. Reter:  Well I think the thing to know is at its core it’s just good medicine and it’s just what we hope to as a medical center, as a treatment group, are providing for our patients anyway. Sometimes when I’ve asked if our facility needs a formal palliative care team; I’ve said no, we just need to do the right thing for our patients and that is recognizing that palliative care is part of everyday practice. There are definitely some – sometimes we’ll have patients coming from specialty centers and say wow I saw a palliative care specialists at the university center. Do you guys have that there? And I have to say no, we don’t have that particular resource, but we try to provide all those resources without bringing another doctor in on the case. In some ways I think, involving another doctor when you’ve got a good relationship with your existing one could be overwhelming to a family whereas I hope that we can continue to provide sort of that continuity of care with the primary care provider to be that piece and that’s my goal for our institution and I think everybody is in agreement.

Host:  Thanks doctor. That’s Dr. Jason Reter, a Family Medicine doctor at the CGH Lynn Boulevard Medical Center. For more information, visit www.cghmc.com or ask your primary care physician. If you or a loved one is in need of a primary care physician, please call CGH Medical Center at 815-625-4790. This podcast is intended for educational and informational purposes only. Please consult with your healthcare professional for specific recommendations about your health. Thanks and we’ll talk again next time.