Lance Shaver, in his Policy Options article, correctly says, “Palliative care is misunderstood and often forgotten,” but he fails to differentiate palliative care from medical care. When palliative care is lumped together with advanced treatment and end-of-life care, patients often think that doing less than “everything” means doing “nothing.” The goal of serious illness management is to create balance between your left and right brains: to weigh medical intervention against leaving well enough alone (see the illustration below).
As an emergency physician, I’m charged with balancing quality of care with quality of life. Are my chronically ill patients better managed in the hospital or at home? Most of these patients recognize that being admitted to the hospital is more dreadful than beneficial. As one patient remarked, “I seem to be getting worse instead of better.” When patients have an incurable illness, can they still feel better? Quality of life begins at home, and home-based palliative care can provide the necessary resources to manage chronic illness outside the hospital.
As Shaver notes, quality of life can include home care and nursing support, management of pain and symptoms, and support for families and caregivers. None of these services need the direct involvement of a physician. Hence, palliative care might be seen as a nursing practice rather than a medical specialty. Training physicians to provide quality of life or personal wellness is misguided. The practice of medicine promotes artificial wellness and distracts patients from taking personal responsibility in making their own decisions. Palliative nurses could specialize in home remedies that provide patients more control and fewer side effects (such as stress).
In choosing their goals and personal values, patients will lean toward either “more is better” or “less is more”; everyone decides through “shared decision-making” between the two sides of your thinking. Using your right brain will bring you a better understanding of palliative care.
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