FLORIDA'S HOSPITAL TO TALK ABOUT
THE PALLIATIVE CARE TREATMENT.
>> GOOD MORNING, I'M KIRSTIN
O'CONNOR.
PALLIATIVE CARE IS SKY ROCKETING
IN THE U.S. AND ANY PATIENT
SUFFERING FROM CRITICAL INJURIES,
FLORIDA HOSPITAL IS MAKING SURE
THIS COMPASSIONATE KIND OF CARE
OFFERS COMFORT INSTEAD OF
AGGRESSIVE TREATMENT.
JOINING US HE HAVE TWO DOCTORS
FROM FLORIDA HOSPITAL, THE
MEDICAL DIRECTOR OF PALLIATIVE
MEDS AND ETHICS AT FLORIDA
HOSPITAL AND DR. DAVIS, MEDICAL
DIRECTOR OF THE CARDIOVASCULAR
INSTITUTE AT FLORIDA HOSPITAL.
WELCOME TO FLASH POINT.
SO I THINK WE JUST BETTER START
OFF BY EXPLAINING WHAT IS
PALLIATIVE CARE FOR ANYONE WHO
HAS NEVER HEARD OF IT.
>> SO PALLIATIVE CARE IS A CARE
WE PROVIDE TO OUR PATIENTS AND
THEIR FAMILIES.
AND LOOKING AT MORE OF THE
HOLISTIC APPROACH TO THAT.
IT'S THE MEDICAL ILLNESS WHICH IS
USUALLY AN ADVANCED ILLNESS.
IT'S PROVIDING SUPPORT FOR THE
PAIN, NONPAIN SYSTEMS.
PSYCHOSOCIAL SUPPORT, FOR EXAMPLE
IF THEY'RE HAVING ANXIETY, IF
THEY NEED HELP WITH THEIR DAY TO
DAY ACTIVITIES AND COLLABORATING
WITH ALL OF THE ALTO AUNTS AND
TRYING TO BRING THE BEST THAT
MEDICAL CARE HAS TO OFFER AND THE
BEST QUALITY OF LIFE THAT THE
PATIENT CAN THEIR FAMILY CAN
HAVE.
>> AND SO I KNOW YOU BOTH
COLLABORATE AT FLORIDA HOSPITAL
TO BRING THAT QUALITY OF LIFE TO
ALL OF YOUR PATIENTS AND YOU,
DR. DAVIS HAVE SEEN A LOT OF
PATIENTS THAT ARE SUFFERING FROM
THOSE LIFE-THREATENING
DISEASES -- LIFELONG DISEASES.
>> SO ONE OF THE FASCINATING
THINGS ABOUT HEART DISEASE IS
THINGS THAT USED TO KILL, WORSE
THAN STAGE 4 CANCERS IN THE
'60s, NOW PEOPLE CAN LIVE 40,
50 YEARS.
NOW, THE QUESTION IS ALWAYS HOW
TO BEST TAKE CARE OF THE WHOLE
PERSON.
AS SOMEBODY IN THE CARDIOVASCULAR
DISEASE WE FOCUS ON THE DISEASE
STATE.
WHAT PROCEDURES WE CAN DO, WHAT
DRUGS MAY BE EFFECTIVE FOR THE
TREATMENT OF THE HEART FAILURE
AND WHATNOT.
BUT WE DON'T SPEND AS MUCH TIME
ABOUT WHAT TRULY IS BOTHERING THE
PATIENT.
AND THIS ALLOWS US TO HAVE MORE
OF A TEAM OR HOLISTIC APPROACH TO
THE PATIENT, BOTH TRYING TO TREAT
THE DISEASE, BUT ALSO TREAT THE
PATIENT AND THE FAMILY AND ALL
THE OTHER THINGS THAT ARE GOING
INTO HOW THEY EXPERIENCE THEIR
LIVES.
BECAUSE IT ISN'T ABOUT JUST
MAKING THEM LIVE LONGER OR MAKE
THEIR HEART FUNCTION A LITTLE
BETTER.
IT'S ABOUT HOW THEY FEEL, AND HOW
THEY CAN GO ABOUT THEIR DAY TO
DAY LIVES.
RIGHT.
AND WE TALKED A LITTLE BIT ABOUT
THIS, BUT HOW IS THIS DIFFERENT
FROM LET'S SAY HOSPICE CARE.
>> HOSPICE IS END OF END-OF-LI
CARE.
IT IS THE LAST OPTION WHERE THE
PATIENT HAS A FEW WEEKS O FEW
MONTHS TO LIVE.
PALLIATIVE CARE IS CONCURRENT
CARE.
IT IS COMBINED WITH ROUTINE CARE.
FOR EXAMPLE, IF A PATIENT IS
RECEIVING ADVANCED THERAPIES,
THEY CAN RECEIVE PALLIATIVE CARE
AS WELL.
IF THEY ARE RECEIVING
CHEMOTHERAPY OR RADIATION THEY
CAN RECEIVE PALLIATIVE CARE AS
WELL.
IF THEY ARE HAVING ADVANCED
ISSUES WITH LIVER DISEASE OR THEY
MAY BE ON A TRANSPLANT LIST FOR A
LIVER TRANSPLANT, WE CAN STILL
PROVIDE SOME -- SUPPORT FOR THE
PATIENT AND THE FAMILY AS THEY
MAKE THAT TRANSITION IN SERIOUS
ILLNESS.
>> SO WHY IS IT SO IMPORTANT TO
BOND YOU TWO TGETHER IN YOUR
SPECIALTIES?
>> I DON'T THINK WE CAN WORK
ALONE.
MEDICINE HAS A LOT OF ADVANCES.
THERE ARE A LOT OF THINGS GOING
ON AS FAR AS TECHNOLOGY AND
TRANSPLANT AND ALL THAT WAS IS
CONCERNED, BUT THE PATIENT AS A
PERSON IS IMPORTANT TO US, THE
PATIENT AND THEIR VALUES ARE
IMPORTANT TO US.
THEIR BACKGROUNDS ARE IMPORTANT
TO US, SO GETTING TO KNOW THE
PERSON AND BRINGING THEM INTO THE
PICTURE AND THEIR QUALITY OF LIFE
AND THEIR VALUES BECOMES OF
UTMOST IMPORTANCE AND THAT'S WHY
WE HAVE A CLEBURNE RAVE ROLE.
>> AND DR. DAVIS WAS TALKING
ABOUT THE TECHNOLOGY THAT WE HAVE
NOW.
I MEAN, YOU BASICALLY CAN KEEP
SOMEONE ALIVE FOR AS LONG AS -- A
LOT LONGER I GUESS THAN --
>> FOR THE MOST PART UNLESS YOU
HAVE LIVER FAILURE OR BRAIN
FAILURE, WE HAVE PLACEMENTS FOR
ALMOST ALL OF IT.
BUT THE QUESTION ALWAYS IS IS IT
REALLY WHAT THE PATIENT WANTS?
AND OFTEN IT'S IMPORTANT TO
SEPARATE WHAT THE PATIENT WANTS
VERSUS WHAT THE DAUGHTER OR SON
OR OTHER MEMBERS OF THE FAMILY
WANT.
BECAUSE A LOT OF OUR TREATMENTS
ARE NOT LIKE TAKING A PILL OR
GETTING AN IV OR GETTING A SHOT.
THEY'RE NOT PASSIVE TREATMENT.
THEY'RE VERY ACTIVE TREATMENTS,
SO FOR SOMEBODY TO BE SUCCESSFUL
AFTER A LUNG TRANSPLANT, A HEART
TRANSPLANT, A LIVER TRANSPLANT OR
VENTRICULAR DEVICES, REPLACEMENT
OF THE HEART FUNCTION, ET CETERA,
IT REQUIRES AN ACTIVE ROLE, AND
THAT MAY NOT BE WHAT SOMEBODY
REALLY WANTS.
PARTICULARLY AS YOU GET OLDER,
YOU MAY NOT WANT TO MAKE THE
DECISIONS TO HAVE THESE VERY VERY
ACTIVE THERAPIES THAT WILL MAKE
YOU FEEL WORSE BEFORE THEY'LL
MAKE YOU FEEL BETTER.
THEY'RE BIG SURGICAL PROCEDURES,
THERE'S A LOT OF DISCOMFORT
ASSOCIATED WITH IT.
THEY CAN BE TREMENDOUSLY
BENEFICIAL FOR THE RIGHT PATIENT.
>> AND IT'S JUST IMPORTANT TO
START HAVING THESE CONVERSATIONS
WITH YOUR FAMILY, WITH YOUR
PARENTS AS PEOPLE ARE WATCHING
THIS.
SO WHEN WE COME BACK WE'RE GOING
TO FOLLOW UP WITH BOTH OF YOU
DOCTORS FROM FLORIDA HOSPITAL AND
TALK ABOUT WHEN THE RIGHT TIME IS
TO HAVE THOSE TOUGH HEALTH
CONVERSATIONS WITH FAMILY
MEMBERS.
WE'LL SEE YOU IN JUST A F
>> WELCOME BACK TO FLASHPOINT.
TODAY WE ARE TALKING WITH TWO
FLORIDA HOSPITAL DOCTORS, THANK
YOU BOTH AGAIN FOR BEING HERE
WITH US FOR FLASHPOINT.
AND EARLY HE WERE WE WERE TALKING
ABOUT SOME OF THE GOALS FOR
PALLIATIVE CARE.
LET'S GO OVER THAT ONE MORE TIME.
WHAT ARE WE TRYING TO ACCOMPLISH
WITH THIS TYPE OF CARE THAT SOME
PEOPLE HAVEN'T HEARD ABOUT?
>> SO WHAT WE'RE TRYING TO
PROVIDE IS A TEAM OF PEOPLE WHICH
COULD BE SOCIAL WORKERS,
PHYSICIANS, NURSES, AND
THERAPISTS, PHYSICAL THERAPISTS,
OCCUPATIONAL THERAPISTS AND ALL
OF THAT T ENHANCE THE QUALITY OF
LIFE OF A PATIENT AND THE
FAMILIES AS THEY'RE GOING THROUGH
AN ADVANCED ILLNESS.
AND THAT BECOMES VERY IMPORTANT
BECAUSE THIS I A COLLABORATIVE
CARE MODEL.
IT IS NOT EITHER/OR.
IT IS NOT END OF LIFE.
IT IS SOMETHING THAT WILL
PRESERVE THE QUALITY OF LIFE.
IT'S THE RIGHT CARE AT THE RIGHT
PLACE AT THE RIGHT TIME.
>> YEAH, FOR THE PATIENTS.
YOU'VE EMPHASIZED THAT.
>> ABSOLUTELY.
>> THE CENTRAL FOCUS.
>> SO WHEN CAN WE START HAVING
THESE CONVERSATIONS WITH AGING
PARENTS?
>> I THINK STUDIES HAVE SHOWN THE
RIGHT TIME TO MAKE DECISIONS
ABOUT WHAT KIND OF CARE YOU WOULD
WANT WOULD BE WHEN YOU'RE HEALTHY
AND SEEING YOUR DOCTOR AT ANNUAL
VISITS.
THAT'S THE MOST SUCCESSFUL PLACE,
NONTHREATENING ATMOSPHERE.
WHERE YOU CAN HAVE A VERY CASUAL
CONVERSATION, BUT YOU POINT OUT
WHO WILL MAKE THE DECISION WHEN
THINGS DON'T WORK OUT WELL?
WHERE DO YOU WANT TO BE?
DO YOU WANT ALL SORTS OF
TECHNOLOGY TO BE APPLIED WHEN
THERE IS A NEED OR DO YOU WANT
COMFORT MANY YOUR HOME?
ALL THOSE THINGS CAN BE SPELLED
OUT WHEN YOU'RE HEALTHY AND WELL
AND LIFE GOES ON.
I DON'T THINK WE SHOULD WAIT FOR
AN EVENT OR A SERIOUS ILLNESS TO
HAPPEN.
THE BEST TIME TO DEAL WITH IT IS
WHEN YOU'RE HEALTHY.
>> THE TIME IS NOW, RIGHT?
>> AND YOU SEE A LOT OF THESE
PATIENTS WHEN THEY'RE AT
POTENTIALLY THEIR WORST IN THEIR
HEALTH.
WHY IS IT IMPORTANT TO TALK ABOUT
IT BEFORE?
>> BECAUSE A LOT OF TIMES WHEN
YOU ARE AT YOUR SICKEST IS NOT
THE TIME YOU'LL MAKE THE BEST
DECISIONS AND IT'S ALSO A VERY
STRESSFUL TIME NOT ONLY FOR
YOURSELF BUT FOR ALL OF THE
LOVED-ONES THAT ARE INVOLVED IN
YOUR OVERALL CARE, IE, WHO ARE
YOU GOING HOME WITH, HOW DO THEY
VIEW YOUR ILLNESS OR YOUR
POTENTIAL LIVING AND DYING
COMPONENTS, SO BEING ABLE TO
SEPARATE OUT A LOT OF THOSE
EMOTIONS IS EXTREMELY IMPORTANT.
IT DOESN'T MEAN THAT YOU
SHOULDN'T HAVE THOSE DISCUSSIONS
AT THAT TIME, IT JUST WOULD BE
BETTER IF FROM A LESSEE EMOTIONAL
PERSPECTIVE YOU ARE MAKING
CONSCIOUS DECISIONS ABOUT WHAT IS
MOST IMPORTANT TO YOU.
JUST BECAUSE WE CAN DO SOMETHING
DOESN'T MEAN WE SHOULD.
AND FOR THE MOST PART, THERE ARE
VERY FEW THINGS THAT I CAN'T DO
TO AN INDIVIDUAL FROM A TECHNICAL
STANDPOINT, BUT THERE ARE A LOT
OF THINGS I SHOULDN'T DO.
>> WHEN WE'RE TALKING ABOUT
HEALTHCARE AND POTENTIALLY
MEDICARE FOR SENIORS ON A FIXED
INCOME.
HOW DOES PALLIATIVE CARE WORK
INTO THAT?
SO FOR THE PATIENT OR FOR A
RESIDENT OR MEDICARE RECIPIENT
THERE'S REALLY NO OUT OF POCKET
COSTS FOR PALLIATIVE CARE.
PALLIATIVE CARE IS MORE AT
ASSISTANCE LEVEL, AT A HEALTH
SYSTEM OR HOSPITAL OR OUTPATIENT
LEVEL, BUT WE'RE PROVIDING IT AND
OF COURSE ONE OF THE BIGGEST
ISSUES IS WE HAVE A SHORTAGE OF
PALLIATIVE PHYSICIAN'S.
IT'S A NEW SPECIALTY.
BUT EVERYBODY DOES A LITTLE BIT.
FOR EXAMPLE, DR. DAVIS ALSO HAS A
PALLIATIVE TALK WHEN HE TELLS THE
FAMILY THAT MAYBE THIS IS NOT A
GOOD OPTION FOR YOU OR THE
PATIENT.
ON THINGS LIKE THAT WOULD REQUIRE
AN EMBEDDED APPROACH, EVERYBODY
HAS A PIECE OF IT.
LOOK FOR AN ADVANCE SPECIALIST
MODEL AND OF COURSE WE ARE
AVAILABLE TO HELP.
IT'S JUST THAT THERE'S A SHORTAGE
OF PALLIATIVE PHYSICIANS COUNTRY
WIDE.
>> WHEN YOU TALK ABOUT THE
SHORTAGE, HOW CAN W MAYBE
INCREASE THE NUMBER OF PALLIATIVE
SPECIALISTS IN O AREA?
>> SO, YOU KNOW, FLORIDA IS RATED
AS A B AS FAR AS PALLIATIVE CARE
PRESENCE IS CONCERNED, BECAUSE,
YOU KNOW, WE NEED TO ENHANCE THE
PROGRAMS ACROSS THE STATE,
CENTRAL FLORIDA, ORLANDO, ALL
THESE AREAS SO THAT THIS IS
AVAILABLE AS PART OF THE ROUTINE
CARE FOR THE PATIENTS.
AND I THINK CMS IS WORKING
TOWARDS THAT, THE HEALTH SYSTEMS
ARE WORKING TOWARDS THAT AND I
THINK THE FUTURE DOES LOOK GOOD
WHERE PATIENTS WILL HAVE THE
OPTION OF ASKING FOR WHAT
ENHANCES QUALITY OF LIFE, WHAT
PAIN MEDICATIONS THEY NEED, WHAT
KIND OF SUPPORT DO THEY NEED IF
THEIR DAUGHTER IS SUPPORTING THEM
AND SHE'S THE CAREGIVER AND SHE
HAS BABIES OF HER OWN SHE DOESN'T
GET SANDWICHED INTO THIS.
>> I KNOW WE HAVE A SPECIAL GUEST
COMING TO CENTRAL FLORIDA SOON TO
TALK ABOUT PALLIATIVE CARE.
CAN YOU TALK A LITTLE BIT ABOUT
THAT.
>> SURE.
>> HE IS A PHYSICIAN, HE'S A
SURGEON AT HARVARD, AND HE HAS
TAKEN UP THE ILLNESS MODEL.
AND OF COURSE LIKE EVERYTHING
ELSE IT TOOK AN ISSUE IN HIS
FAMILY TO REALIZE THAT PALLIATIVE
IS IMPORTANT, HE WENT THROUGH HIS
FATHER'S ILLNESS AND HE WROTE
ABOUT THAT JOURNEY, SO THAT BOOK
IS CALLED IMMATERIAL MMORTAL.
HE'S COMING TO THE CENTER ON
SEPTEMBER 21ST.
IT'S A FREE, YOU KNOW,
ENGAGEMENT, FREE LECTURE AND
PEOPLE CAN ATTEND IT, THEY JUST
HAVE TO REGISTER AT THE WEBSITE.
>> ONE MORE WAY TO JUST GET A
LITTLE BIT MORE INFORMATION ABOUT
THIS --
>> EXACTLY.
IT'S A VERY GOOD BOOK, I
RECOMMEND THAT EVERYONE SHOULD
READ IT.
>> WE THANK YOU BOTH FOR HER
BEING HERE TODAY, JOINING US ON
FLASHPOINT AND WE HOPE THAT YOUR
MESSAGE IS SHARED WITH A LOT OF
OUR VIEWERS.
>> WE ROBBERY IT AND WE'LL BE