The Case For “Primary Palliative Care”

2018-01-02T18:04:41+00:00 December 1st, 2017|

I realized recently that I take Palliative Care for granted.  I was invited to speak to the community of Juneau, Alaska, by the city’s Federation on End of Life Care.  It was the third time I had been invited to speak by an urban organization with a mission to change the culture around death and dying in that city.  But this was different.  

The Tucson and Dallas communities where I spoke have the luxury of robust, interdisciplinary Palliative Care programs in their hospitals.  But Juneau has only Bob Urata, a dedicated and extremely hard-working family practitioner. Urata has been the volunteer medical director of Juneau’s very small hospice since 1986. Although he is board-certified in Hospice and Palliative Care medicine, he has no formal fellowship training and no palliation-focused interdisciplinary team to support him. My host, Hal Geiger, President of the Foundation for End of Life Care in Juneau, put it this way: “Bob does his best to manage dying patients in between delivering babies, counseling diabetics, and worrying about my cholesterol.”

In a sense, Bob Urata is taking on responsibilities that I believe every doctor should. Why?  Even in my work in the “big city” of Oakland, where Palliative Care is plentiful, I see that there is no way to provide these services to every patient who could benefit. Almost every patient with serious illness should have access to excellent symptom management and skillful communication, skills which are unfortunately only found consistently within the field of Palliative Care. And there will never be enough of us to attend to all of these patients.  That is why it is clear to me that every physician, oncologist to surgeon, should have some basic palliative care competence to offer their patients, a concept called “Primary Palliative Care.” Specialty consultations by Palliative Care practitioners would be reserved for more complex cases. This is the only sustainable way to do what needs to be done.

So kudos to Bob Urata for leading the way.  Still, the man could use a little help.  Any Palliative Care physicians out there want to go fishing?

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