MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'James Hallenbeck, M.D.' source. Mon, 17 Nov 2008 22:47:17 +0100 http://growthhouse.typepad.com/james_hallenbeck/2008/11/palliative-care-and-the-cult-of-cure.html Discussions about the relationship between palliative and non-palliative care rightly note that these two aspects of care can and often should operate synergistically.  Begging the obvious – it is not just the dying who wish not to suffer in illness.  However, there is still something about this palliative/non-palliative dichotomy that bugs me.    In my more extreme moments, I have ranted about what I have labeled the cult of cure.  This “cult” takes a truly radical position.  The apparent goal of this group is to cure – everything.    All disease would disappear.  Presumably, even old age and death would be vanquished.  Like the fairy tale, the goal apparently is to live “happily ever after.”  While thi... James Hallenbeck, M.D. blogs http://www.medworm.com/rss/comments.php?id=1955207 Thu, 13 Nov 2008 05:12:45 +0100 1955207 http://growthhouse.typepad.com/james_hallenbeck/2007/03/improving_the_q.html Joanne Lynn and colleagues have just come out with a great new book, The Common Sense Guide to Improving Palliative Care. (OxfordUniversity Press, 2007).  Like their prior work in this area (Improving Care for the End of Life, now in a revised version, 2007), this pocket-sized book discusses quality improvement strategies.  Using explicit examples from teams working in various venues in which palliative care is practiced (palliative care consult teams, ICU, nursing homes, hospices, etc.) the authors demonstrate how measurable improvement can be accomplished by following some straightforward quality improvement steps. In reading the book one is struck over and over by the thought, “Yup, that really is common sense.  The rationale for the described projects (improving pa... James Hallenbeck, M.D. blogs http://www.medworm.com/rss/comments.php?id=496978 Fri, 23 Mar 2007 16:52:49 +0100 496978 http://growthhouse.typepad.com/james_hallenbeck/2006/10/got_palliative_.html I was at a meeting of champions for palliative care the other day, which included a brainstorming session of priorities for the future.  The usual culprits were rounded up - changing reimbursement structures, addressing concerns about quality of care, working on improving continuity of care, and education, among others.  One suggestion caught my attention – the need to deliver one message in one voice.  My first thought was that the timing for this was premature.  Significant differences of opinion exist on a host of issues and these differences need to be respected.  “One voice, one message,” runs the risk of shutting out needed debate and suppressing dissent; it is not always a good thing to ‘stay on message.’  But it also occurred to me that perha... James Hallenbeck, M.D. blogs http://www.medworm.com/rss/comments.php?id=463998 Thu, 12 Oct 2006 15:51:35 +0100 463998 http://growthhouse.typepad.com/james_hallenbeck/2006/09/the_birth_ofa_n.html Yesterday, September 19, 2006 the American Board of Medical Specialties (ABMS) voted unanimously to establish a new medical subspecialty of Hospice and Palliative Medicine.  This action follows similar approval on June 26 of this year by the American College of Graduate Medical Education (ACGME).What does this mean?  At the simplest level, this new medical subspecialty now has the same formal status as, say, Cardiology or Oncology.  In my opinion, this is to be celebrated.  Subspecialty status has both symbolic and practical importance.  Symbolically, such status represents legitimacy within the world of traditional medicine.  This buys us a “seat at the table.”  Practically speaking, subspecialty status will open up new funding streams for training a... James Hallenbeck, M.D. blogs http://www.medworm.com/rss/comments.php?id=464000 Wed, 20 Sep 2006 21:31:05 +0100 464000 http://growthhouse.typepad.com/james_hallenbeck/2006/08/famous_last_wor.html A time for last words will come for us all.  Some, will be treasured by families as precious legacies.  Some, will be lost, muttered in dreams or spoken to an empty room.  A very few will become Famous Last Words.   Why is it we seek out these words?  Perhaps we are looking for the perfect ending, a coda, summing up life in a neat little bundle.  We imagine last words to be a person’s most honest statement of self, a solution to any residual puzzle, stripped of any artifice.  Whether witty, noble, or tragically reflective of stubborn ego, these most personal haikus stand as testimony to our collective humanity. Why is our attention drawn to certain Last Words and not others?  Of course, we have a vested interest in the Last Words of those w... James Hallenbeck, M.D. blogs http://www.medworm.com/rss/comments.php?id=464002 Fri, 11 Aug 2006 23:17:23 +0100 464002 http://growthhouse.typepad.com/james_hallenbeck/2006/06/disappearing_in.html Again, this year I was honored to MC KARA's annual meeting, held on June 9th. (KARA website) Below, are my introductory remarks. Disappearing into pictures A modern Zen master once spoke of dying as “disappearing into pictures.” Those words resonated with me and I think of them often. People have different ideas about where we go when we die. Wherever it is, those of us still living continue our relationship with those who have gone before us. I think the master was prompting us to think not only about death, but these relationships with the departed. When I first walked into the VA nursing home in Menlo Park many years ago to work as a physician, I was greeted by rows of pictures on either side of the entrance corridor - pictures of young men and women in uniform, mostly in black ... James Hallenbeck, M.D. blogs http://www.medworm.com/rss/comments.php?id=464004 Mon, 12 Jun 2006 22:18:26 +0100 464004 http://growthhouse.typepad.com/james_hallenbeck/2006/04/volunteers_and_.html One of the more enlightened aspects of the Medicare Hospice Benefit is the requirement for certified hospices to have volunteer programs.  Because of this, volunteers have become an integral part of Hospice culture.  Let’s consider the role of the volunteer in end-of-life care. Dying is both an intensely personal and yet public experience.  Most dying people are dependent on others for medical care and basic support.  In the past, the responsibility for such care fell first and foremost on the family, which was in turn supported by the larger community.  The provision of medical care by professionals was at most an ancillary service.  Today, much care is provided by professionals.  Families and the community too often have little, if any, role - ... James Hallenbeck, M.D. blogs http://www.medworm.com/rss/comments.php?id=464006 Wed, 05 Apr 2006 21:35:53 +0100 464006 http://growthhouse.typepad.com/james_hallenbeck/2006/01/tube_feeding_th.html Last month, a task-force of gastroenterologists published an excellent review article on tube-feeding in a major GI journal, Gastrointestinal Endoscopy.  (DeLegge MH, McClave SA, DiSario JA, Baskin WN, Brown RD, Fang JC, Ginsberg GG . Ethical and medicolegal aspects of PEG-tube placement and provision of artificial nutritional therapy.  Gastrointest. Endo.  2005; 62(6): 952-959) I was honored to be asked to write an accompanying editorial, which is available free at: http://journals.elsevierhealth.com/periodicals/ymge  (Unfortunately, the far more important review article is not free, but may be ordered or available through your medical library.)  In recent years, a number of studies, well referenced in the review, have demonstrated little or no benefit for tube fe... James Hallenbeck, M.D. blogs http://www.medworm.com/rss/comments.php?id=464008 Fri, 27 Jan 2006 01:00:31 +0100 464008 http://growthhouse.typepad.com/james_hallenbeck/2005/11/_the_hasting_ce.html The Hasting Center, the leading bioethics organization in the United States just released a special report entitled, Improving End of Life Care – Why has it been so difficult. Link to Hastings Center Special Report   Contributors to this report include Daniel Callahan, co-founder of the Hastings Center, and Joanne Lynn, among other luminaries.  It’s a worthwhile read.  The consensus reflected in the articles seems to be that leaders in the field have relied too much on untested assumptions.  In particular,  the focus of much early advocacy (1960’s-mid 1990’s) for better care focused excessively on the role of medical ethics in general and more specifically the primacy of the ethical principle of autonomy.  Later studies, in particular the now famous SU... James Hallenbeck, M.D. blogs http://www.medworm.com/rss/comments.php?id=464010 Wed, 30 Nov 2005 01:03:07 +0100 464010 http://growthhouse.typepad.com/james_hallenbeck/2005/08/fallen_leaves.html I thought readers might be interested in the following reflection, which I offered at this year's annual KARA convention in the Spring.  KARA is a wonderful grief support group in the Bay Area, with roots going back to 1976 (within one year of the first hospices in America).  Our VA hospice program has worked closely and collaboratively with KARA for many years. They have been of special help in offering support to bereaved children.  Link to KARA website I think back to a KARA conference some years ago. The presentations were moving, leading me to a deeper contemplation. When a break came, I took a stroll in the hotel garden. The sky was bright blue and the flowers so fresh. A small stream ran through the perfectly manicured grounds.&nbs... James Hallenbeck, M.D. blogs http://www.medworm.com/rss/comments.php?id=464012 Wed, 24 Aug 2005 20:18:46 +0100 464012 http://growthhouse.typepad.com/james_hallenbeck/2005/08/palliative_care.html Physicians-in-training have a peculiar ritual called, "Journal Club."  The idea is a good one - a group of physicians get together periodically to discuss some article of common interest.  Often, a junior trainee, medical student or intern, attempts to critique the article, while senior faculty critique their critiques.  In practice, the ritual is often a deadly bore.  Its not really a club (the term implies voluntary membership and participation is usually anything but voluntary).  The "clubs" often meet at inconvenient times, like dinner time, and the focus is excessively on journal articles.  So if I'm not exactly a fan of "journal club," why am I writing about it?  Because the idea is still basically a good one - if it is... James Hallenbeck, M.D. blogs http://www.medworm.com/rss/comments.php?id=464014 Wed, 17 Aug 2005 18:32:06 +0100 464014 http://growthhouse.typepad.com/james_hallenbeck/2005/08/status_of_nursi.html This report suggests at least in this state there is cause for concern. Link to the California Healthcare Foundation  See attached PDF of the report: Download FragileNursingHomeIndustrySnapshot2005.pdf WHY SHOULD THIS BE OF CONCERN TO THOSE OF US IN PALLIATIVE CARE? It is increasingly likely that Americans will spend some time in a nursing home prior to death and that more of us will likely die in nursing homes.  If this is news, it probably is not welcome news.  The reasons for this are complex, but relate to an aging population (baby boomers coming 'on-line' as elders), gender roles (women less likely to accept caregiving roles at home because of dual incomes etc.), and geographic dispersion (children moving far from parents etc.)  Nursing ho... James Hallenbeck, M.D. blogs http://www.medworm.com/rss/comments.php?id=464016 Tue, 16 Aug 2005 22:32:41 +0100 464016