Looking forward to the next Virtual Grand Rounds on early interdisciplinary palliative care for people who inject drugs. Is injection drug use a life limiting illness? What’s a crude mortality rate? How can I best deploy my palliative care team to meet the needs of these complicated patients? Learn all of this and more from Ben Thompson and Lauren King (and potentially more friends schedule depending) next week. Lauren King is the senior social worker at Prisma Health / the University of South Carolina and Ben is a doctor on her team

Click on their picture to watch the lecture!

What a privilege it is to be up here today speaking with the new inductees to the Gold Humanism Honor society. I am very grateful to receive the Leonard Tow award.
Humanism in medicine. It’s kind of a funny concept when you think about it. For the students who are being inducted and for everyone who’s gone through it, medical school is all about learning about pathology and disease processes. One thing that I have come to see in retrospect as a twelfth-year medical student is that we don’t actually learn everything about disease processes. Even in family medicine, my residency which we describe as taking care of people from birth to death, we don’t learn about what happens at the very end of life or we’re so uncomfortable with the concept that we’re not providing our patients with optimal care. That’s part of the reason I went into palliative medicine.
For anyone who has gone through an OB rotation or happens to be a recovering OBGYN like Dr. Cook, we’re all familiar with the birth plans that some people bring to the hospital. “I want to be surrounded by these people, I want this music playing, I want the lighting exactly this way, this is what I want to do with a cord or // whatever people are doing with placentas these days. We do our best to honor those things even if some of them seem a little far-fetched or uninformed. But at the same time, in the last 5 years that I’ve been practicing palliative medicine, I have yet to see someone who has come in with a written death plan. I would imagine they look pretty similar to the birth plans when you think about it. I want these people here. I want this music playing, I want to be at home, I want to be in the hospital. I know that if presented with a plan like this, the medical team would do their best to honor it, as far-fetched or uninformed as it may be.
The problem is we don’t talk about death. We learn about heart failure or dementia, we even learn when to recognize something as “end- stage” but we don’t take that logical leap to tell the patients the implications of this diagnosis. I would encourage you all to take that logical leap and ensure that you and your patients are on the same page.
All of the students who are being inducted today have spent time with the palliative medicine team and for those who have rotated with me. Sometimes, when approaching a patient for the first time, I’ll say something like “take your patients on a 5-minute speed date.” Now I want to be clear, I am not saying that you should date your patients because you should clearly not date your patients. But ask your patients the important questions. You can ask a patient who is nearing the end of life about what’s important to them. I can guarantee you it’s not related to a disease process. Even if they have a transfusion dependent leukemia, their transfusions are not important to them. What’s important is what the transfusions allow them to do. Maybe it’s spending time at home, time with loved ones, or something that may seem trivial to us like doing the sudoku. My grandfather died when I was a third year med student and he loved doing the Sudoku. He did the Sudoku the morning that he died, and for the sake of a good story, I’ll say that he did it right.
My charge to you, you amazingly humanistic students, residents, and physicians, is to move past the disease process and to look at the patient in front of you as a person. Put their disease into the context of their life and care for the patient. Most of the time that will be by treating the disease.
A quick aside –  there are really only three goals for treating a disease. The first is cure. If I had a broken leg I would hope that the doctors would fix my broken leg. I will be cured of that issue. If I have HIV or diabetes or heart failure, cure isn’t an option. In that case, I would hope that the team would maximize my quality of life by giving appropriate disease-directed treatments that will allow me to do the things that are important to me. And if there comes a time for me, and there will come a time for me – Life is the only condition with 100% mortality rate. If the time comes and my disease cannot be cured and the symptoms have become more burdensome than the disease itself, I hope that my physicians will have the insight, humanism, and the patient centeredness to treat me the patient with dignity and respect by managing my symptoms as I die. Just three things, it’s pretty simple, isn’t it. We are curing, prolonging life through disease-focused treatments, or managing symptoms at the end of life. Ensure that your patients know which of these things you’re doing.
These are hard conversations. We asked lots of hard questions in medicine. Everyone here has learned how to take a sexual history. And just like a sexual history, it’s only weird if you make it weird. If you need the information to take care of the patient, you get the information and you do so in a way that normalizes the question to the patient. Normalizing doesn’t mean stumbling around and saying “Hey. These are some weird questions I’m going to ask, but I have to ask everyone so..”, no. It means asking the question using your expertise as a clinician and doing so in a way that opens the door for the patient.
As I leave you today, I would remind you that the Hippocratic Oath saying “do no harm” does not mean providing maximal life-prolonging treatment to every patient. Your oath is to establish what a harm is to the patient in front of you and avoid that. Most people would say that dying is a harm, but maybe your patient who is dying of cancer and will die with or without cardiac resuscitation would say that performing CPR is a harm. But you won’t know until you ask.
So talk to your patients, get to know what’s important to them. You may find that it can be a heavier weight to do so. So as you do that, remember to take care of yourself. A career in medicine is a marathon, not a sprint. Incorporate appropriate self-care early into your training, and if you’re not early in your training, maybe this may serve as a reminder that self-care is vitally important. Think about one thing you could do when you leave here today or as you go to the hospital next week that will help you care better for your patients. Thank you again for your time, I am honored to receive the Leonard Tow Humanism in Medicine award, and I am looking forward to celebrating your induction together.