Editor’s Note: The following post was written by two contributors: Jean Kriz, MD, an emergency physician, and Sheri West, RN. Both of them serve on the same palliative care team at OSF Saint Anthony Medical Center in Rockford, Illinois.
Jean Kriz, MD – Emergency Physician
When I started this part-time position as a palliative care physician a year ago, I felt like I was jumping into the deep end of the pool. I thought I would be woefully under-qualified to take on this role as I had no experience in palliative care as an emergency physician… or did I?
A large part of palliative care is symptom management. Do I do this in the emergency department (ED)? You bet I do! Why does a person come to the ED except for symptom management? The ED is not the place to go for a “check-up,” although some have tried! ED physicians manage a wide variety of symptoms ranging from pain and nausea to fatigue and anxiety every shift we work.
Another important role of the palliative care physician is to assist in decision-making. This is integral to the practice of emergency medicine. Family meetings are very common in the ED, although the circumstances and the setting are quite different. The biggest difference is that these meetings are not scheduled and usually take place due to the need for an immediate decision as to the direction of care.
Finally, establishing good working relationships with primary care physicians and specialists is crucial to successful coordination of care for our patients. As an emergency physician, I have extensive interaction with these individuals during every shift I work. They seem more receptive to my calls, however, when I am wearing my palliative care “hat!”
Does this mean that I was immediately comfortable in my new role as a palliative care physician? Of course not! The last several months have been a wonderful adventure of learning and growing with moments that have been triumphant and moments that have been awkward and painful. But what a great adventure! It is one that I hope will continue for many years to come.
Sheri West, BSN, RN, CHPN – Palliative Care Nurse
An emergency physician can bring a unique perspective to the support of patients and families seen by the palliative care team. This physician usually practices in a very fast-paced environment focused on aggressive treatment and life-sustaining interventions.
When the emergency physician bridges their care to the palliative care team, they open conversations with patients and families that explore the medical preferences of patient for future care beyond the current admission.
The palliative care team become involves with patients faced with serious illness or chronic diseases progressing to end stage or end of life. There will come a point in which aggressive medical interventions will no longer promote life but prolong the natural dying process. Patients often respond to the current treatment provided during a hospitalization, though they are unable to maintain an optimal condition once discharged.
An emergency physician takes a unique look into the future to question if the patient returns to the emergency department . . . . What then? What can be offered? Is the treatment in alignment with the patient’s medical preferences?
The emergency physician, as a palliative care team member, has influenced the entire team to envision the patient’s disease process to anticipate the needs of patients and families. Supporting patients and families as they explore medical preferences is an important conversation to prepare them for the fast-paced emergency department environment to ensure the patient’s decisions are honored.