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Program offers doctors a different way to care

Palliative medicine focuses on the seriously ill and their families

SEATTLE – It was a personal experience that first exposed Dr. Christine Cofer to palliative medicine.

During her late teens, when her father was suffering from metastatic kidney cancer and conventional treatments could no longer help him, he started receiving hospice care.

The nurses and social workers who came into their home were a calming presence during a difficult time, Cofer, an internist, said.

“It was a really positive experience for my family.”

When it was time to choose a subspecialty, Cofer, a 42-year-old former substance-abuse counselor, decided to go into palliative medicine.

As demand grows for palliative care, a field focused on alleviating pain and increasing quality of life for seriously ill patients and their families, so does the need to formally train doctors in the subspecialty.

Palliative medicine, which includes hospice care, addresses the physical, psychological and spiritual well-being of patients with advanced diseases and their family members.

Doctors must learn pain-management techniques, how to deal with the emotions of patients and how to work with a team of nurses, social workers and even spiritual advisers.

There are 62 medical-school programs across the country offering such training.

One is the University of Washington School of Medicine which, in partnership with Providence Hospice of Seattle, is piloting the only palliative fellowship program in the state.

Cofer, first physician to participate in the University of Washington program, said her interest in the humanistic side of medicine attracted her to palliative care.

“It was sort of a natural step for me,” Cofer said. Palliative medicine “allowed me to practice medicine the way I was taught in medical school – you spend more time with people to talk about the things that contribute to suffering.”

Most medical students are exposed to palliative and hospice care in school and in residencies, but until recently, formal training and certification in the field has not been widely available.

Palliative medicine was designated a subspecialty in 2006 by the American Board of Medical Specialties and Accreditation Council for Graduate Medical Education. The board offered the first certification exam last year.

Trainees in the yearlong program must complete a residency in one of 11 specialties that include internal medicine, anesthesiology, family medicine, and obstetrics and pediatrics. They must also train in hospitals, hospice settings and a long-term facility such as a nursing home.

That this type of care is becoming mainstream represents “a sea change for the practice of medicine,” said Wayne McCormick, director of the University of Washington’s Palliative Medicine Fellowship Program.

Still, many lay people may not know what hospice care is until they have a personal experience with a palliative-care team, he said. And “because it’s so patient- and family-centered … the value becomes palpable when you’re actually in the middle of it.”