By Matt Perry
“Medicine is not a science,” said Dr. Eric Cassell to a packed room at the annual Coalition for Compassionate Care of California conference in Sacramento last week. “Clinical medicine, the care of the sick, takes place between the doctor and patient in an almost magical, interpersonal relationship.”
Medicine as magic?
During his keynote speech, the long-time palliative care physician lamented the loss of a founding principle in American medicine: the intimate relationship between physician and patient.
“We’re seeing a generation of physicians who have lost its sense of being a doctor,” said Cassell. “Most of them have forgotten how important it is to have a relationship with the patient … We understand less about people than we did in the 1970s.”
A fearless, old school physician unafraid to toss out casual obscenities, Cassell echoed a lost generation of physicians who still made house calls and offered their full attention during office visits.
Long considered the step before hospice, palliative care can actually be offered at any stage of a serious illness and focuses on humane treatment. It is sometimes called “comfort care.” It’s quickly becoming mainstream just as hospice – unknown before the 1970s – has now become standard medical procedure for those with fewer than six months to live.
Cassell – author of the 1980s classic The Nature of Suffering and the Goals of Medicine – spoke about different approaches to palliative care, inspiring this question:
Which would you want at your bedside during a serious illness?
Dr. Michael Fratkin evoked a wholly different vibe when talking to the breakout session “Grassroots Palliative Care.” Easygoing and casually dressed with an unmistakable hippie-physician personality, Fratkin spoke reverently about Humboldt County where he’d lived and practiced medicine in large health systems for decades.
“Everywhere I go in Humboldt County are ghosts and friends of ghosts,” he said.
But practicing medicine took its toll.
“Fried to a crisp,” in 2014 Fratkin left medicine and hit the road on a personal journey of discovery.
Soon after, three seminal events brought him clarity: the publication of Atul Gawande’s best-selling book Being Mortal; the report Dying in America from the National Academies of Sciences, Engineering and Medicine; and the death of former California resident Brittany Maynard who moved to Oregon to take advantage of its assisted dying law, spawning nationwide legislation including California’s own End of Life Option Act.
Back home, Fratkin used social media to quickly discover what was missing in the community he loved: palliative care.
In response, Fratkin launched an Indiegogo fundraising campaign.
“Forty days later I had raised $140,000, more or less to create a palliative care team,” he said. Today he heads a staff of 17 that cares for 118 patients.
“And it happened because I asked the community what they needed,” said Fratkin. “I turned my attention away from big systems and health plans and turned it towards neighbors and the people I cared for.”
‘The groundwork is empathy’
The third physician, Dr. B.J. Miller of UCSF Medical Center, spoke about how palliative care can go deeper.
Missing three limbs (all but his right arm) following an accident as a Princeton sophomore, the affable Miller talks like a man thankful for being alive with his distinctly humanist approach to death and dying. His TED talk, “What Really Matters at the End of Life,” has been viewed over 5 million times.
“If our subject matter is suffering and death, then the groundwork is empathy,” said Miller. “Staying inspired, loving the people you love, that’s your job.”
While palliative care has traditionally addressed physical pain and emotional distress, Miller hopes to further expand its definition to embrace deeper social, intellectual and spiritual aspects as well.
“Where I’d love us to progress is existential distress,” said Miller. “Maybe death has a lot to do with how we experience everything.”
A better path?
A fourth physician is the only one attached to an Academy Award nomination — Dr. Jessica Nutik Zitter.
An ICU physician specializing in palliative care at Highland Hospital in Oakland, Zitter is featured in this year’s Oscar-nominated short documentary Extremis.
Zitter also has a new book, Extreme Measures: Finding A Better Path to the End of Life, blogs for the Huffington Post and will soon be featured on the Dr. Oz television show.
During the conference, Zitter called for a “new kind of heroism” in which doctors eschew life-saving measures for more thoughtful, compassionate care.
She recounted her own hard knock lessons: being told by a hospital-patient liaison that she was “torturing a patient” and hearing the bones of a frail elder crunch as a team attempted to resuscitate her unsuccessfully for 30 minutes.
Zitter then described a new approach to death and dying – her “new heroism” – recounting the tale of a colleague and patient who finally stopped invasive cancer treatment in favor of a celebration with wine and cake.
Cabernet over chemo.