Charles F. von Gunten, MD, PhD is the Provost at The Institute for Palliative Medicine at San Diego Hospice. As one of the foremost experts in the field of palliative care. Dr. von Gunten has published and spoken widely on the subjects of hospice, palliative medicine, and pain and symptom control.
Our knowledge about relieving the suffering associated with serious illness has never been more powerful in the years of recorded medical history than it is now—but it isn’t a standard for health care. Hospice care was the first place where new approaches to relieve suffering and improve quality of life have been developed over the last 50 years. Just like other improvements developed first in the terminally ill, those discoveries don’t apply ONLY to the terminally ill, but to those with chronic illness. Consequently, the development of palliative care programs in hospitals and clinics throughout the country and around the world has followed. Palliative care is a way to make all that new knowledge available to people before they are dying—when they have months and years to reap the benefits—even if they are cured!
Palliative Medicine is the fast growing new medical subspecialty that concerns itself with the relief of suffering. Have you heard of it? Is it in your community? Physicians are part of the interdisciplinary palliative care team with the chief aim to provide quality-of-life.
Does it matter? About half of all hospitals have some aspect of a palliative care consultation service. If you are a glass-half-full kind of person, its good news. More people are getting better attention to their symptoms and the other components of suffering. If you are a glass-half-empty kind of person, you’ll note that composition and quality is variable. The Institute for Palliative Medicine at San Diego Hospice has the largest training program for physicians specializing in this new field—they go on to be consultants in the nation’s hospitals and hospices.
What’s missing? Consumer demand. In contrast with the revolution in birthing that happened when women demanded that their needs be better met, there is little demand for improvement in the relief of suffering that accompanies serious illness. Consequently, there is little pressure to accelerate the pace of change.
You can make a difference. Speak up about the suffering associated with your illness. Expect that your physician will either address the pain and suffering that you and your family experience, or expect that the doctor will be able to ask for a consultation within your health system to provide the expertise. With this knowledge one shouldn’t have to make a choice between cure of illness and relief of suffering – they should go hand-in-hand and patients should demand as much.