Managing end of life care is a huge problem facing the healthcare system. Everyone dies eventually, and while doctors may initially try to extend patients’ lives as much as they can, there always comes a time when the problem must change from fighting the disease to managing the pain.

I am a premedical student, and I’ve shadowed both internal medicine (gastroenterology and neurology) and surgery (general surgery) to get a glimpse of life in the medical field. Palliative cancer care, however, is completely new to me. In palliative care, even the simple ways problems are framed change. Patients often prefer to die in the comfort of their own homes, surrounded by their loved ones, so a prime concern of palliative care doctors is first, whether a patient can get the care they need at home instead of at the hospital, and second, whether they can provide basic palliative care support to patients at home rather than forcing them to come to the hospital.

Shadowing palliative care was fascinating. At first, I was a bit apprehensive that the language barrier would prevent me from really absorbing what was happening, but often the emotions being conveyed can easily transcend language. You could see pain in patients’ faces and hear concern in their voices. While in internal medicine I was used to patients getting a battery of diagnosis-related questions, palliative care is highly concerned with quality of life surveys. One of the doctors we are working with here used a quality of life survey that is used at MD Anderson (the ESAS survey, if any of my readers in the medical profession have heard of it), and every time patients are visited, the key question they look at is how reported quality of life has changed since the past visit.

Another interesting twist was that many of the palliative care patients were being treated at home. I feel like the patient-doctor dynamic is very different when medical staff is visiting a patient in his or her home, as opposed to in the hospital. It’s almost as if the patient, as the host in his or her comfort zone, has a lot more power and I think it makes doctor-patient relationships a lot more friendly and open than I was used too. Almost less formal? It definitely felt more comfortable for patients, so something was working!

The cancer hospital has a lot of initiatives in mind to improve palliative care. We’ve talked to Dr. Edmundo Mauad, the director of the hospital about proposed offerings ranging from a palliative care tablet application that patients could use to communicate their condition to doctors from their homes to a full-scale mobile unit that would come to patient homes. Dr. Mauad noted that while palliative patients so often want to stay at home for care, this often left quality to vary by the economic status of the patients. A full scale mobile unit, where patients could elect to come into the mobile unit for care or have doctors come into their homes, is one idea proposed to equalize care for all, regardless of their economic position. It’s a pretty interesting initiative, and one of many things I was struck by in my visit.