There are times when a surgeon cannot offer treatment that will cure a disease or even alleviate symptoms. Palliative Care is about more than alleviating suffering at the end of life. It means using the patient’s goals to guide decisions about what treatment to provide. I first encountered Palliative Care when treating critically ill patients, but now the principles of Palliative Care inform how I provide care throughout my entire practice.
The principles of Palliative Care for the surgeon, as defined by the American College of Surgeons in 2005, start with respect for patient dignity and autonomy. Whenever a surgeon cannot offer curative treatment or recommend a surgical intervention to treat a disease, she must ask what else can be offered to alleviate suffering. When discussing end-of-life issues, the focus of treatment often shifts to symptom management or prevention. Discussing end-of-life issues, however, should be considered in all care that a surgeon provides.
Surgery often causes symptoms while curing or treating a disease process. Curing a disease is not the only important outcome, our patients tell us maintaining their quality of life cannot be overlooked.Each time a surgeon proposes an intervention, she must consider the symptoms that it may cause. Palliative Care teaches her to discourage interventions that are not likely to achieve a patient’s goals.
While the principles of Palliative Care can often be applied to care provided by the surgeon, it is important to recognize that patients, families, and caregivers benefit from the involvement of palliative care providers. I request input from the palliative care team when a patient has a limited life expectancy, severe symptoms not improving with treatment, or when a surgical intervention may not be expected to cure a disease process or alleviate symptoms. Sometimes we discuss the options and decide to pursue a surgical intervention in keeping with specific goals. Sometimes we decide that the patient will be best served by pursuing hospice care. Most importantly, we work together to focus on the patient’s goals and symptoms. That is how Palliative Care helps me to provide patient-centered care.
Lillian Erdahl practices breast and general surgery at the University of Iowa. She serves as Associate Program Director in General Surgery as well as the head of the Iowa City VA Medical Center Breast Clinic. Her research interests include breast cancer prevention, faculty development, and simulation in teaching clinical examination.She completed her General Surgery residency at Penn State University including two-year research fellowship in surgical education. After residency, she also completed a one-year fellowship in breast surgical oncology at the Mayo Clinic in Rochester, MN. She is fluent in Spanish and completed a minor in Spanish while pursuing her BS in Biology at Iowa State University.Outside of the hospital, she enjoys yoga, cross-country skiing, cooking, and gardening. Her husband, two children, and cat help her to find joy in each moment of the day.
She microblogs as @lillianerdahl supporting issues and organizations on social media where we all have an opportunity to make an impact. She would like to remind everyone to ask questions about how their donations benefit patients before giving money support breast cancer awareness.
Our blog is a forum for our members to speak, and as such, statements made here represent the opinions of the author and are not necessarily the opinion of the Association of Women Surgeons.