Models and Mentors
In Conversation with James Hallenbeck, MD
James Hallenbeck, MD, assistant professor of medicine, is the director of Palliative Care Services at the Palo Alto Veterans Affairs Health Care System where he specializes in include physician education, non-pain symptom management and cultural aspects of end-of-life care with a focus on intercultural communication. Hallenbeck has spoken extensively about his expertise and authored the book Palliative Care Perspectives.
Please briefly define the field of palliative care and describe the
issues fueling its current growth.
Palliative care evolved from the hospice movement. Two factors have driven the palliative care movement. The first, is a recognition that it is not just the terminally ill who can benefit from palliative approaches to care, which am to alleviate suffering and improve quality of life. The second, is the incorporation of palliative care programmatically into the hospital setting and into training programs. Palliative medicine is in the process of formally becoming a sub-specialty of medicine and many hospitals are now incorporating palliative care consult teams into their organizations. Within the VA palliative care consult teams are now mandated for all VA facilities.
What skills are important to have to successfully practice palliative care within a diverse patient population?
It would be great if all disciplines working with patients needing palliative care had formal training incorporated into their basic competencies. Unfortunately, such is not yet the case for many disciplines at many schools. Among basic competencies needed are skills in cross-cultural communication. While curricula exist to enhance such skills, again, they are rarely formally taught. Fortunately, many excellent resources now exist on the Web, for those who wish to pursue such training independently. For example, the Stanford Geriatric Education Center (GEC), has an on-line course on inter-cultural communication on-line.
What do you find most rewarding about working in palliative care? Most difficult?
Almost always, we can make a real difference. Its incredibly rewarding to work with a patient or family, who have been having a very hard time, suffering heavily, and then come up with something that alleviates at least some of that suffering. When someone has been in terrible pain or vomiting uncontrollably and we can make it better, that's incredibly rewarding. We also encounter much sadness in our work and that is difficult. But most difficult for me, personally, is dealing with the reluctance of many to embrace palliative care as a legitimate field in Medicine. Too many hospitals and too many providers still view palliative care as unnecessary or, sometimes as a luxury that cannot be afforded. Palliative care is NOT a luxury we cannot afford. I believe we cannot afford to do without it.
Posted: 6/9/05
