Palliative Care vs. Supportive Care: Dawn of Injustice
(or Episode VI - Supportive Care is the Jockstrap of Medicine)
Dramatis Personae (in order of appearance):
Dr. Darren Cargill: Palliative Care physician, advocate, award winner
Nurse: a nurse
Rumpelstiltskin: imp, the Queen will never win his game
Matthew McConaughey: Hollywood A-lister
Alyson Hannigan: TV star, Personal Support Worker (PSW) for this tale
Slim Shady: a.k.a. Eminem, rapper, has issues
Connor MacLeod: the Highlander
Thanos: ultimate villain of the Avengers and Guardians of the Galaxy movies
The following is a piece of satirical fiction. If you don’t know what that is, might I make a Modest Proposal that you read some more Johnathan Swift?
This conversation never happened. But if it did, it would have happened as an uber-long Canadian Heritage Minute (the original ones that aired on CBC and CTV preferably that we all remember nostalgically). The setting is a complex continuing care unit somewhere in Ontario.
A palliative care doctor and nurse walk into the building…
Darren: Huh? What’s that? (points at a sign) “Welcome to the Supportive Care Unit”. Huh?
Nurse: What on Earth is a Supportive Care unit?
Darren: I have no idea. Isn’t this the Palliative Care unit?
Nurse: Well, it’s the same building, same floor, same wing. So yeah, it must be.
Darren: This must be a mistake. I feel like John Cabot when he discovered Newfoundland. Maybe we should ask someone.
Just then a little gnome of man appears from out of nowhere.
Rumpelstiltskin: Hello my puzzled friends. You seem to be lost. Perhaps I can be of assistance.
Darren: Perhaps you can. You see, we are looking for the Palliative Care unit. You know, where patients receive Palliative Care…
Rumpelstiltskin: Nooooo! Don’t say that name. It is hideous. It is scary. Supportive care is so much nicer. It is soothing. It just rolls off the tongue……sssssssupportive. See?
Darren: Oh FFS. Not this again. I mean I always thought it was a little weird that our PCU was housed in the “Centre for Healthy Aging and Mobility,” of which my patients are neither, but I went with the flow. But are we really going to have this argument again about whether we should call it Supportive Care or Palliative Care? Man, this is like a health care zombie that just needs to die. Speaking of which…
Nurse: Can someone please tell me what the difference is? What is Palliative Care and what is Supportive Care?
Darren: Ok, here is the Coles' Notes version. “Palliative” was a term coined by Dr. Balfour Mount - a Royal College-trained urologist - in 1974 to encompass an area of medicine often neglected by the medical field: end of life care. Dr. Mount felt that even patients with an incurable illness still deserved great medical care. Just like Marconi was the first to receive the first trans-Atlantic radio signals,
Mount was the first to use the word “palliative care” regularly. He dedicated his career to the field of Palliative Care. On the other hand, Supportive Care is just a name that someone made up because people seem to be afraid of the word “Palliative”. Seems a bit irrational to me, being afraid of a word.
Matthew McConaughey: “It’s a Fugazi….Pffftttfffttttt”
Nurse: I agree. I mean, isn’t it a bit disrespectful to Balfour Mount that we use a BS term like Supportive instead of Palliative. I mean, he is the father of the modern hospice and palliative care movement in Canada.
Rumpelstiltskin: Stop saying that word!
Darren: Pop quiz: do you know where term palliative was coined?
Nurse: No, please enlighten me.
Darren: Montreal. The term Palliative comes from the Latin word palliare – to make hidden. Do you know where supportive care was coined?
Nurse: Vancouver? Seems like something they would do. [ed: au contraire. Euphemisms are a Madison Avenue specialty]
Darren: Nowhere. It’s a made-up word for a made-up field. Fun Fact, though: Canada invented basketball!
Rumpelstiltskin gets flustered, stomps his feet petulantly and put his foot clear through the floor. He then grabs his leg and in the process of wresting from the ground, tears himself in two.
Nurse: Ouch that’s gotta hurt but it illustrates a good point nonetheless. Putting your foot through the floor may break your bones but names (like Palliative) will never hurt you. But let’s play Devil’s Advocate for just a second. Maybe a simple name change is all that is necessary. We already know that too few patients receive Palliative Care (16-30% in Canada according to Senator Carstairs in 2010) and many are often referred only in their simpulan days and weeks. Maybe there is some merit to this?
Darren: Listen, this whole idea about changing the name is frankly ridiculous. It’s like calling an enema a “rectal douche”...all of sudden people will start to line up for them? [ed: I'm going to use 'rectal douche' in a future post or tweet the instant an opportunity arises]. A rose by any other name is still a rose (error intentional). Nobody freaks out when Neurosurgery or Cardiac Surgery are mentioned by name, and hacking into someone’s brain or chest is bedwettingly frightening. Nobody is saying we need to change their names, but somehow mention Palliative Care and it strikes Pavlovian fear into the hearts of patients and health providers alike. [ed: 'bedwettingly'? Again with the adverbs?]
Just then PSW Hannigan walks up to the group wearing a button saying, “Hello, My Name is Palliative Care.”
Slim Shady: (avoids making eye contact): Hello, my name is…, my name is…
PSW Alyson Hannigan: “Say my name, bitch!” [ed: I'm going to have Destiny's Child stuck in my head all night]
Darren: Well said, Alyson.
PSW Alyson Hannigan: Thank you, and this one time, at grup band camp…
Darren: TMI. See, the whole argument that poor access to Palliative Care is because of its name is ludicrious (unlike Ludacris who is an American rapper). It really has less to do with the name and more to do with the stigma. We live in a death-fearing and death-denying society (stole that from Kathy Kortes-Miller). And as members of this society, doctors tend to be a bit leery when it comes to talking to their patients about death and dying. Rather than referring your patient to Palliative Care, which will engender an honest and frank discussion about death and dying, most physicians would rather refer to Supportive Care, which no one will question and the difficult discussion is avoided.
Nurse: Case in point: a 2016 article published in The Oncologist shows just that. It was the attitude of oncologists around end of life (EOL) that dictated their comfort, either providing Palliative Care themselves or referring when it was needed. Seems to me this is all just an attempt to avoid difficult conversations about death and dying, which simply feeds into the myth that no one ever dies and we all live forever.
Connor MacLeod: Speak for yourself, lassie. I am Connor MacLeod of the Clan MacLeod. I was born in 1518 in the village of Glenfinnan on the shores of Loch Shiel. And I am immortal. [ed: I could really go for about 1518 mL of Glenfiddich to restock my cabinet]
Nurse: Good for you, Highlander. Hmmm…maybe this is all about superstition. It’s like that book by Kathy Kortes-Miller called Talking about Death Won’t Kill You. Everyone knows that talking about death won’t actually make it happen or happen faster. Frankly, all this talk about changing the name because of a fear of Death seems just a little juvenile.”
Just then a purple Mad Titan sitting on a floating throne turns his head and grins.
Thanos: Did someone say...Death?
Darren: As Canadians, we should be proud of this Canadian Heritage Minute (looking at you @HistoricaCanada). Palliative Care is no longer just about end of life care and is often provided concurrently with treatment to prolong survival. Some programs are even looking at providing it alongside treatment for curative intent, if only resources permitted.
Thanos: I could make that happen…(holds up a gem studded gauntlet, ready to snap his fingers)
Nurse: If only it were that easy.
Darren: In this year of all years we should be honoring the term Palliative Care. Dr. Balfour Mount is being inducted into the Canadian Medical Hall of Fame in London, ON on April 12th and while he is not just being inducted for coining the phrase “Palliative Care”, he is being inducted for his dedication to patients and bringing this concept to Canada. The profession of medicine and all of our patients owe him a debt of gratitude. While some may call Wilder Penfield the Greatest Canadian, many of us hold Dr. Mount in the same esteem. [ed: wait...the Greatest Canadian isn't Don Cherry?]
Let’s not dishonor him by whitewashing the term he coined for his life’s work and those professionals who have dedicated their careers to the sick and incurable.
Nurse: I agree. Dr. Mount is a national treasure. He’s like the Superman of Palliative Care. It just seems like an injustice to try and plaster over the very term that has meant kindness, compassion and humanity to all manner of ill and dying patients.
Darren: At some point, we need to stop and think about this. Do we want to do things the easy way and just change the name? Or do we want to do the right thing and change attitudes? Let’s start by changing hearts and minds, not by making superficial and cosmetic changes. If there is a stigma attached to Palliative Care, let’s shed light on the stigma rather than running away from it. Funny thing about stigma...it tends to come back. Kind of like those health care zombies. This idea that changing Palliative Care to Supportive Care just won’t seem to die. We need to stand up against it and do the right thing.
Nurse: You mean like how Superintendent Sam Steele bravely stood up to that American without even drawing his gun?
Darren: Yes, exactly like that.
Dr. Balfour Mount will be inducted into the Canadian Medical Hall of Fame on April 12th in London, ON. Tickets are available at: https://cdnmedhall.org/induction-ceremony
Join me in asking @HistoricaCanada (info@historicacanada.ca) to produce a Canadian Heritage Minute for Dr. Balfour Mount to commemorate one of his timeless contributions to the field of Palliative Care...its name.
Kathy Kortes-Miller’s book is available at Chapters and on Amazon. We simply cannot wait for the sequel, Oh Snap! Talking About Death Just Killed Your Mother...Sorry.
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Thursday, March 22, 2018
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death,
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nurses,
palliative care,
political correctness
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