Inpatient and Outpatient US Clinical Experience in Palliative Care in Dallas

Information about this clinical experience:

You will be under the supervision of a physician who is board-certified in both internal medicine and palliative care. After years of practice as a hospitalist and primary care physician, this doctor is now a palliative care physician devoted to providing support, easing suffering, and improving quality of life for patients and their families facing serious illnesses. The preceptor has hospital appointments within the Medical City and Baylor Scott & White Health Systems. The attending is actively involved in the education of internal medicine residents; these residents are with the preceptor for two-weeks at a time.

The evidence shows that most physicians in practice feel uncomfortable providing palliative care. Much of this is due to a relative lack of education in palliative care during medical school and residency. Given the shortage of trained palliative care physicians, it is necessary for physicians in nearly every specialty to have exposure to palliative care so that they can meet the needs of these patients.

In this clinical experience, most of your time will be spent seeing patients with the preceptor in the outpatient clinic. These are primarily patients with cancer. As you accompany the physician from one encounter to another, you will learn how to assess and manage the varied needs of these patients. This will include not only their physical needs but also their social, psychological, and spiritual needs.

As you would expect, conversations with dying patients and their families are difficult. You will observe how an experienced physician uses patient-centered communication to establish and strengthen relationships and engage patients and their families in shared decision-making.

Additional goals of this clinical experience are learning how to:

• Recognize when patients should be referred for palliative care

• Obtain a psychosocial and spiritual history

• Evaluate pain in patients

• Select between pharmacologic and non-pharmacologic pain management options

• Develop approaches for the evaluation of common physical symptoms in patients with advanced disease (e.g., anorexia, dyspnea, nausea and vomiting, constipation, delirium)

• Assess and treat psychiatric symptoms

The inpatient component of this experience will take a place at a local hospital. In a typical month, the attending will visit the hospital twice to perform inpatient consults. You will also have the opportunity to spend one entire day in the hospital seeing patients with palliative care nurses who are consulted by different specialty services. In contrast to the outpatient clinic where patients have cancer, these hospital consults will involve a wide array of medical illnesses.

Useful articles to read before the rotation include:

• NCCN Guidelines Insights: Palliative Care

• NCCN Guidelines: Supportive Care

Rotators may also be able to volunteer at a nonprofit organization in the local area that partners with hospice programs and palliative care organizations. Students interested in taking part in volunteer work should let the preceptor know on the first day of the rotation.

Please note that this rotation will only be offered as an observership rather than a hands-on experience.