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November 10, 2017

Dr. D’s November Medical Update

 

In this month’s article, I’m going to devote this space to National Hospice and Palliative Care month. In past years, I’ve talked about this topic for part of an article, but this year, I think it is worth a more in depth discussion.

To begin, hospice is thought to be many things by many people. It is not a place, necessarily. It is a level of service, usually in a patient’s home. It is not a place to send people to die. It is not a “death bed” service for those with only days to live. It is not just for cancer patients. And, most importantly, it is not a resignation to hopelessness or despair.

My personal experience with hospice came when my mom had suffered enough and decided she was ready to stop treatment. Hospice for her was a place, an inpatient unit, and it provided her a comfortable place to spend her last days. The level of care and service she received, and the support we received when we were with her made the transition easier.

It is not a place. Hospice is a service and is given in the patient’s home. It provides a higher level of service that allows patients to remain in their homes as they transition through their illness. In order to qualify for hospice, a patient must have a terminal diagnosis and be expected to survive 6 months or less. There are many diagnoses that qualify for hospice: heart conditions, respiratory conditions, kidney disease and cancer are just some of the broad categories that qualify.

It is not a deathbed service. In my career, I’ve had several patients who “graduated” from hospice. That is, their condition improved to the point where they were expected to live more than 6 months. I’ve had other patients that chose not to go on dialysis when their kidneys failed and lived for more than a year on hospice.

Cancer is a common diagnosis for entering hospice, but, as I said earlier, it is not the only condition that qualifies. My father was on hospice for a time due to Alzheimer’s disease. I’ve had other patients on hospice due to congestive heart failure, liver disease, and lung disease. Again, as I stated earlier, the key is that the patient is expected to live no more than 6 months at the time they are admitted. Regular assessments are made every 3 to 6 months to determine if the patient still qualifies for hospice. If a patient doesn’t decline in health or improves, they can be discharged from hospice.

So, now that we know about hospice, the question becomes “why” hospice? When a cure for a patient’s condition is no longer possible or a patient chooses to stop treatment, hospice can be a good alternative. In the population I serve, treatment is sometimes worse than the condition. Chemotherapy can be very hard on patients and stopping therapy and entering hospice may provide a overall better life. Some patients choose to stop dialysis, or never start, because they don’t want that type of life.

As with most issues in life, the key is conversation. We should talk about what we want at the end of life and, as a family member, we should listen with an open mind and open heart to what our family wants.

 

Michael Dominguez, MD, FAAFP is board certified in Family Medicine. His office is located at HealthTexas Medical Group, 590 N. General McMullen, 78228, phone: 210-249-0212.

 

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