holding handsRonald Crossno recently published an opinion piece in the Austin American Statesman (8-28-13) about several bills in Congress aimed at increasing the number of healthcare professionals trained to provide hospice services. The bills are: Palliative Care and Hospice Education and Training Act (H.R. 1339 and S. 641) and Patient Centered Quality Care for Life Act (H.R. 1666). These bills, if passed, would provide Federal support for training and various other activities aimed at increasing the availability of palliative care.

These are excellent initiatives and hospice is a most excellent concept. Let’s say that I agree with 98% of the purposes of these bills, but in the back of my mind is a question. One large goal of these bills, and by inference the healthcare providers who support them, is the expansion of specialty training for physicians and other service providers.

I think we do the overall effectiveness and affordability of healthcare a disservice by creating specialties where the specialty is focused on what, as is the case with palliative care, should be every healthcare providers concern.

I agree, we need highly specialist surgeons who can operate sophisticated robots to do delicate brain surgery on the small segment of the population who needs such skills. However, on the other hand, palliative care and hospice seem to be more in the category of what everybody needs to do as routine and integrated practice. I would rather see these two bills focusing on 1) undergraduate medical and other entry-level healthcare education and 2) the integration of palliative care into the basic mindset of all providers and consumers.

We tend to create these specialized training programs, that produce specialists, who then need a specialized center to offer the service. We then work for years to get insurance and government to pay for it, and in the end, spend twenty or thirty years maintaining this specialized structure that, perhaps, ever so slowly, diffuses into general practice. The end goal can get lost in the day-to-day. For example, hospice, developed by Dame Cicely Saunders in England in the 1960’s, is still not a part of everyday care, as evidenced by the existence of the two bills above, after half a century.

I realize there is a tradeoff when trying to make a new idea (hospice, for instance) common practice. One needs advocates and people skilled in the practices. However, creating specialties where the need is unwarranted just increases training costs, adds more bureaucracy to licensure, and creates specialized practice niches that add additional costs to the consumer.

I do think we need to have long range strategies when developing new ideas and methods that have as the end goal making services widely available, easily accessible and highly affordable. To date, we tend to do just the opposite.

Join us for a real-time discussion about the ideas raised by this essay on Tuesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

Reference and Resources

  1. Crossno, R. Congress can improve patients’ quality of life. Austin American Statesman, Editorial, Aug. 28, 2013. http://www.mystatesman.com/news/news/opinion/crossno-congress-can-improve-patients-quality-of-l/nZcmh
  2. American Academy of Hospice and Palliative Medicine.
    Ronald Crossno’s blog at the AAHPM: http://www.aahpm.org/apps/blog/?author=165
    Academy web site: http://www.aahpm.org
    Consumer web site: http://www.palliativedoctors.org
  3. History of Hospice, National Hospice Foundation web site:   http://www.nationalhospicefoundation.org/i4a/pages/index.cfm?pageid=218

Image Source: http://www.stlouis.va.gov/services/Palliative_Care.asp