Thread by @WesElyMD

1/🧵 PRIMARY vs SPECIALTY #PalliativeCare:

When I combine intensive care w palliative care as an ICU doc, I’m delivering PRIMARY palliative care. I often consult a board-certified palliativist for additional help, & this is SPECIALTY palliative care. Today…
#medtwitter

https://twitter.com/anandiyermd/status/1414203810982109184

2/ Today the most complicated thing I did in the ICU were NOT bronchoscopy or restarting a heart. It was helping people navigate these massive life choices, often shifting the treatment ladder we are climbing from the wall of cure to the wall of comfort. To me it’s the best…

3/ To me, primary #PalliativeCare is the most nuanced and critically important part of my vocation as an Intensivist. Just as the Winter gets you to a mountains 🏔, but Summer keeps you there, Palliative Care is not what brought me to the ICU but it definitely keeps me here.

4/ The whole point of what we do in the ICU is ultimately to reduce suffering, but we can’t do that well unless we understand this part of our job. Yet medical schools don’t teach it and most of it is learned by modeling ourselves after mentors. Rounds went a bit long today…

5/ At numerous patients’ beds we had the privilege of meeting with pts & families & shifting focus either towards comfort measures or more aggressive approaches depending on the specifics of their diseases, hopes and goals. THIS is ICU medicine.

6/fin
Students and house officers contribute so much to these conversations. They tell me it’s sometimes the most valuable part of their ICU rotation. Make a point to include them & let them develop their own style of care. Our PC team teaches me something new every week.