Geriatrics and Palliative Care (and primary care) have a problem. We haven’t learned how to make our work, our mission, “sexy.”
During yesterday’s White House Health Reform open conference call with physicians (reportedly 2700 physicians connected to the call) http://www.healthreform.gov/, an astute participant asked why the White House health reform committee doesn’t hold public education campaigns about end-of-life care to debunk the highly skewed Death Panel myth. The Health Reform representative moderating the call said that was a fabulous idea and that she’d bring it to the attention of the White House, but also encouraged physicians to do their own education and outreach campaigns locally.
As has been noted on GeriPal in other posts and comments, we in geriatrics and palliative care are not the most savvy marketers. The fact that the forces behind the Death Panel–the money, marketing, personalities–can so easily create such a phenomenal stir on the public’s emotions is a testament to how much more effective other entities are in marketing their beliefs (even with little/nothing to back them up). Our problem, in geriatrics and palliative care, is that we are globally poor at PR. Organizations for breast cancer, HIV, leukemia and lymphoma–even colon cancer screening with the endorsement of Katie Couric–have promoted their work and mission so effectively that you can’t open a magazine, walk down a town square, or attend a local 5k or marathon without seeing them represented in an ad, lamppost flag, or banner. To me, the irony is that our aging population carries a significant proportion of the burden of each of these conditions, not to mention the chronic illness or functional debility that they may have at baseline or develop because of the more highly ‘marketed’ conditions.
The lack of education and awareness that the public has about geriatrics and palliative care was made evident to me yesterday morning when I received a call from the daughter of one of my housecalls patients. My 92 yo patient has a colonic tumor and advanced COPD requiring 24hr oxygen. The day prior, during an episode of shortness of breath, she panicked and hit her Lifeline button (which she has because of her frequent falls). An ambulance was called and when they arrived and learned she was on hospice they immediately, appropriately, called the hospice 24hr phone line. She was instructed by hospice to take a dose of her morphine which immediately relieved her shortness of breath and enabled her to relax and breathe more comfortably. Her daughter called me upset because as one of the ambulance personnel left, he commented to her, ” I don’t know why they told her to take morphine. That’s contraindicated with COPD.” I acknowledge that I don’t know who this ambulance staffmember was and whether he was at all medically trained, but regardless, his comment–ill-timed, and ill-informed–caused my patient and her daughter significant distress. The hospice nurse and I both spent time talking to my patient and daughter to reassure them of the indications for using morphine to relieve suffering, and also to explain that, unfortunately, even ambulance personnel do not always understand hospice care and palliative medicine.
If our frontline health care staff (such as EMTs) have no understanding of palliative medicine [and further, by something as simple as a misplaced comment–made while wearing their official medical uniform and carrying a nametag and stethoscope–are able to raise fear], how are we to expect the public to understand the work we do in geriatrics and palliative care? But beyond simply educating all health care practitioners about palliative care, we have a responsibility to also educate the public.