The muddied waters of medical terminology

I thought I would take today’s blog to address a question I’m often asked as a palliative care doctor: what are the differences between palliative care and hospice care?

It can be very confusing for people especially as the terms can have different meanings depending on what part of the world you live in. In Canada, the terms are often used interchangeably to describe end-of-life care. Generally speaking, the term ‘palliative’ is used to refer to the type of care being received, while a hospice often refers to the location of that care (often outside of the hospital setting). Because Canada has relatively few residential-style hospices there is a specific criteria for admittance. Generally speaking, people are admitted to hospices when they need specialized care that they can’t receive at home, but whose conditions are not acute or complex enough to merit hospitalization. But the relatively small number of facilities here means that much end-of-life care in Canada is administered in a hospital’s palliative care unit or in the home.

And this is why things can get confusing.

One of the most common misconceptions about palliative care is that anyone who receives it is necessarily dying. But the fact is, that anyone experiencing a life-limiting condition can benefit from palliative treatments, the idea being that medical assistance can be provided to ease the suffering of anyone at any stage of an illness. Many people in palliative care are undergoing life-prolonging treatments with the goal of resuming ‘life as normal’ upon leaving the facility.

There are also tertiary palliative care units (such as those found in Surrey or Edmonton), designed as emergency facilities to help stabilize rapidly declining patients so that they might ultimately be moved home or to another facility.

As I’ve mentioned, it can be very confusing for patients and families to decode all the differences between programs. Ultimately it’s most important for you to talk with your physician or specialist about all the options available. And as always, ask as many questions as you need to—always make sure you get the answers you need to make the best decision for you or your loved one.

For more information about palliative care in Canada, there are excellent resources available at:





Choosing the right time

When is the right time to move a patient into palliative or hospice care? It’s a question that both family and medical practitioners wrestle with, and one that’s been examined in a recent journal article. Unfortunately, the study found that in a great many cases referrals for terminal cancer patients are being made too late. Some oncologists are only referring terminal patients to hospice care after their treatments are complete—which as the article explains may be just weeks or even days before they pass.

So why am I concerned about this finding? Well, the end result of delaying a referral is that the patients don’t really have the opportunity to benefit from the care and may undergo undue physical and emotional suffering as a result.

The reason for this problem is, I think, two-fold. A large part of this stems from the overall lack of understanding from those outside the palliative realm about the exact purpose guiding the services we provide. Palliative care is about giving patients the highest possible quality of life we can during their final days, weeks, or months. People facing a terminal diagnosis often need that kind of support very early on, even if they’re still getting chemotherapy or another type of treatment.

It also speaks to the compartmentalization of modern health care delivery. Far too often one practitioner is unaware of what another is doing, or is unaware of what their relationship is to those services. One of my main goals as both a practitioner and an instructor is to ensure that people understand that palliative care is done best when it’s done in a complementary fashion, recognizing that at this difficult time in a person’s life we have to treat the mind, body and spirit.

Meditating my way towards perspective

Ever since my time at Upaya, meditation has been playing an increasingly important role in my life. In fact, it’s an important part of the coping mechanisms to avoid stress and burn-out that I talked about a few weeks ago.

I’d taken a break from it for a little while, but recently a friend got me back into practicing it more regularly. She sent me this little blurb as a reminder why it had been so important to me to do in the first place:

12 symptoms of a spiritual awakening:

1.   An increased tendency to let things happen rather than making them happen.
2.   Frequent attacks of smiling.
3.   Feelings of being connected with others and nature.
4.   Frequently overwhelming episodes of appreciation.
5.   A tendency to think and act spontaneously rather out of fear based on past experience.
6.   An unmistakable ability to enjoy each moment.
7.   A loss of the ability to worry.
8.   A loss of interest in conflict.
9.   A loss of interest in interpreting the actions of others.
10. A loss of interest in judging others.
11. A loss of interest in judging oneself.
12. Gaining the ability to love without expecting anything in return.

People sometimes get thrown off by the words “spiritual awakening,” but they needn’t be The beauty of meditation is that it requires no religious affiliation to be practiced.. In the context of meditation, it’s really just about achieving psychological balance, calm, and emotional and physical relaxation—what person couldn’t use more of those things their life?

And the benefits of meditation are countless both for medical practitioners and patients. Stress can have a serious negative impact on your health and it’s not to be taken lightly. Meditation can help provide you with the perspective needed to better cope with daily stresses.

With the autumn months come myriad changes and its easy to get bogged down with all the details. It’s the perfect time to embrace the opportunity for self-examination to the balance in our lives we all need and deserve.

Beating the palliative burn-out

One of the most frequent questions I get as a palliative doctor is, “How do you do it—day in and day out?” While burn-out certainly isn’t something that’s isolated to my field of practice, I will say that the toll this line of work can take on you both emotionally and physically is extremely high. Anyone who goes into this speciality and thinks they’re going to be immune to burning out probably doesn’t have a realistic understanding of what this line of work entails.

In fact, seeing families going through difficult times does, in many ways, give me an additional insight into what the effect is of this work on my own well-being. People don’t realize that emotions like grief take an incredible toll on your body. And one of the most important things I tell the families and friends of patients is that it’s incredibly important that you take care of yourself. We’re so focused on taking care of our loved one, that we forget that if we neglect ourselves we won’t be any good to anyone.

Obviously the best tact is to choose something that works for your personality and interests. The most important thing is that you aware that burn-out happens to everyone, and that you need to take steps to avoid it.

Coping mechanisms can include a huge wide variety of things: hobbies or crafts, reading, counselling, or just talking about your emotions, sports, movies, writing, cooking, listening to music.

It’s obviously a very individual thing, but the bottom line is that you make the effort to recognize that exhaustion and burn-out are normal, and that you should never ignore it. But you can do a great deal to help prevent it.

So what do I do? I’ve found that the most important things for me to do are to make sure that I eat well and get a full 8 hours of rest every day (this doesn’t necessarily mean sleep). It’s important that you have decompression time where you can not only unwind, but process everything that’s gone on during the day in a positive way. Then I make sure to get some physical activity during the day. For me, the best way to do this is to take my dog Chase out for walks. Not only do I get the exercise and fresh air that helps physically, but I also get the emotional benefit of a little ‘pet therapy’ from Chase (it’s no myth that people with tend to have lower blood pressure and cholesterol!).

And remember, never be afraid to ask for help. Palliative practioners and caregivers take a lot on their shoulders each day, it’s important to take some of that weight off whenever you can.