Geriatrics/conceptsHospice and Palliative Medicine: New Subspecialty, New Opportunities
Section snippets
Hospice and Palliative Medicine: Overview
Hospice and palliative medicine, a newly designated subspecialty of the American Board of Medical Subspecialties (ABMS), is an advanced-level practice that focuses on the total care of patients with life-threatening illness, whether curable or terminal.1 Although there is a recognition that palliative care is provided by all clinicians, conferring subspecialty status by ABMS gives palliative medicine a well-defined field of practice with a distinct base of medical science on which graduate
Generalist or Basic Palliative Care in the ED
At the present time, the emergency clinician faces clinical dilemmas in palliative medicine without the benefit of either having mastered a set of educational competencies in palliative care or of having a palliative medicine subspecialist at his or her side. Educators in emergency medicine have not yet comprehensively defined or embraced a core palliative medicine skill set for emergency providers. Although emergency medicine develops a core curriculum in palliative medicine, the National
Clinical Case
H.M. is a 68-year-old man who presents with stage IV non–small cell lung cancer that has been refractory to several lines of chemotherapy and now has severe uncontrolled pain in his right chest wall, a known site of bony invasion of metastases. The patient spends most of the day in bed and is eating and drinking very little. He is taking morphine continuous release of 60 mg every 12 hours and rates his pain in his left chest wall as a 9 of 10. His son accompanies him and says he has become
Clinical Case Conclusion
The case of H.M. can now be appropriately managed with the key precepts listed above. Using the cancer trajectory for the patient and observing that the patient is now bed bound, the emergency physician realizes that the patient now has just weeks to months to live. A candid discussion with his oncologist confirms this, and the oncologist reluctantly admits to the emergency physician that, given the patient's functional or performance status, he has nothing more to offer him in the way of
A New Opportunity for Emergency Physicians: The Subspecialty Practice of Palliative Medicine
Emergency clinicians will struggle during the next decade on the optimal skill set and model to provide the best palliative care in the ED setting.103 Currently, emergency physicians with a strong desire to deepen their expertise in palliative care may wish to pursue a career in subspecialty palliative medicine practice. Requisite to successful practice is a willingness to accept death as a normal part of life and move beyond the now obsolete belief that death means failure. Embracing the
Emergency Physicians' Pathways to Palliative Medicine Subspecialty Board Certification
Before the recognition by the American Board of Medical Specialties, the non-ABMS American Board of Palliative Medicine specified criteria for board certification and administered the qualifying examination. With the approval of subspecialty status by the ABMS, all currently certified hospice and palliative medicine diplomates will be eligible to take the new Hospice and Palliative Medicine Certification examination. It is estimated that there are more than 1,500 physicians in the United
Conclusion
Emergency clinicians provide palliative care to patients in their daily practice and have done so since the inception of the specialty. Building on this component of emergency practice, the new subspecialty of palliative medicine has opened to emergency physicians. Whether one pursues specialization or not, all emergency clinicians can use the growing body of knowledge of palliative medicine in their bedside ED practice. Education of current core faculty responsible for postgraduate training is
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Supervising editors: Robert J. Zalenski, MD, MA; Michael L. Callaham, MD
Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Dr. Quest is funded as a co-investigator by the National Cancer Institute (5 R25 CA116472) for work on the EPEC™-Emergency Medicine Project.
Publication date: Available online January 29, 2009.
Reprints not available from the authors.