Thread by @arian_nachat

What is Palliative vs Hospice?

Pal Care & Hospice clinicians helps patients who have life limiting diagnosis - end stage heart, lung, kidney, liver failure, metastatic cancer or progressive Neuro dz like dementia, Parkinson’s, MS, ALS or severe strokes.

2/ the difference between Palliative & Hospice is that the patients still under Pal Care are in a disease modifying stage of their illness - meaning the train has left the building but we can still intervene to change the path their dz takes

3/ Hospice patients underlying life limiting disease EITHER has NO more disease modifying treatment available OR they elect NOT to pursue further treatment. That doesn’t mean we don’t still treat other correctable reversible issues - we still give abc, fluids, pain meds, oxygen.

4/ It is about recognizing that hospice patients life limiting diagnosis can no longer be modified. The goal becomes improving quality of life over longevity. For each patient what defines QOL is different and unique!

5/ Palliative & Hospice care teams are some of the kindest, most compassionate and PATIENT & FAMILY centric advocates you will ever meet or work with! The analogy I often use is that we are your Sherpa climbing Mt Everest - we know where the crevasses are & help guide

6/ NONE OF US ARE EXECUTING ANY PATIENTS. Anyone turning what I do into this political football should be ashamed of themselves. My patients & families are SCARED, CONFUSED & don’t need further fear mongering.

7/ I lay out medical options risks, benefits, alternatives so they can make choices for themselves!!!! We offer all medically appropriate / available options so they understand them and can make an informed personal choice.

8/ patients who enroll in hospice actually live LONGER because we are experts in symptoms management so they are less distressed. Instead of being in a state of flight or flight, they are comfortable and with less stress hormones sleep, eat, live better!!!!

9/ anyone with a life limiting diagnosis should consider meeting with a Palliative care team so they can have an ally and advocate while they navigate challenging decisions. There is no “right” or “wrong” answer. Each decision path in unique to each family.

10/ Anyone w a life limiting diagnosis should have an Advanced Directive completed and designate a Health Care Proxy. My worst cases are ones where patients never talked about their choices and families struggle with guessing what they would want.

11/ We as a society are awful about talking about dying. We all have a one way ticket here - we should normalize talking about dying. Talking about the end of life doesn’t magically hasten it. Processing feelings & emotions is one of the biggest tasks we help with.

12/ So, to all the politicians trying to speak for my profession - #ThisIsOurLane NOT yours. Stay out of my exam room, my doctor patient relationship & learn about what I do before spewing lies.
#HPM #ThoseWeCarry #MedTwitter

@choo_ek @meganranney @AdyBarkan @Atul_Gawande