I’m a palliative care doctor: This is what I do

By Andrew Thurston, MD, physician. 

Palliative care is a young field in medicine, but its origins root deeply in ancient history. The term palliative care comes from the Latin palliare, which means “to cloak.” Its practical origins extend back to the 4th century where “hospices” gave weary travelers respite from the road. It expanded to the medical field in the 11th century around the time of the Crusades and emerged stronger in the 19th century, championed by various religious orders in the United Kingdom and France. Palliative care as we know it today has its modern origins in the hospice movement, with Dame Cicely Saunders beginning her pioneering work with the terminally ill in 1948, and later helping to establish St. Christopher’s Hospice — the first of its kind — in a suburb of London. Since then palliative care has grown – in the United States alone there are now over 3,200 hospices and over 100 accredited palliative care fellowship programs for specialty training of physicians.

Over time, a clear distinction has formed between hospice and palliative care because the two are not the same: Hospice is care specifically geared toward the last 6 months of life, while palliative care is care concurrent with a person’s illness — at initial diagnosis, during active curative treatment, through all the good and bad of a life-threatening condition. Just because someone is seen by palliative care doesn’t mean he is appropriate, or even eligible, for hospice.

Evidence supporting the impact of palliative care on quality of life continues to grow as quickly as the field itself. The landmark New England Journal of Medicine study in 2010 by Temel and colleagues showed how early palliative care involvement not only improves quality of life and symptoms of anxiety and depression, but also improves survival in patients with lung cancer. Other studies have shown that many people don’t want aggressive interventions at the end of life, and yet still receive these interventions. And that people want to talk about death and dying, but often don’t get the chance — because of fear, or lack of physician training in empathic communication, or cultural differences. Or something else entirely.

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