Doctor works to plant the 'palliative care' seed

Mar 26, 2013

Modern medicine is full of innovation.

It can extend life in ways once thought impossible, but those breakthroughs come at great cost and potential risk.

Dr. Fitz Blake believes the future of medicine lies in returning to the core of the doctor-patient relationship.

Dr. Blake is a Michigan physician well versed in the fast pace of the emergency room.

He’s shocked people back to life, set broken bones, and stabilized gunshot victims.  Blake is imposing.  He’s built like a linebacker, and speaks in a deep baritone voice.  
 
He says his traditional medical training taught him and other doctors like him how to identify disease, do procedures, and select the right medicines.  But he’s troubled by what current medical training doesn’t seem to emphasize as much, it’s what health policy experts refer to as “patient centered care.”

“Patients and families need to be able to make informed decisions, and the only way they can make informed decisions is if someone sits down and takes the time with them to educate them about what’s going on as far as their disease and prognosis,” Blake said.

Blake’s quest, to treat the whole patient and not just the problem, is not just professional, it's personal.

His mother was diagnosed with cancer when he was only ten years old.  He remembers his family trying to shield him.  He also remembers how a new team of doctors that treated his mother influenced his current outlook on medical care.

“There were physicians who I noticed on her team that kind of came in and gave a different approach," Blake recalls, "It seemed to me they were more focused on what they could do for her rather than what they could do to her.”

The distinction Blake makes between “for her” and “to her” is significant.  It represents a shift in the dominant medical culture to more actively involve patients in the medical decision-making process. 

What’s at stake are concerns about patient’s rights, medical harm, and the skyrocketing costs of health care.  Blake believes this attitude is not yet part of mainstream medical training.  

In the case of Blake’s mother, his family opted not to continue chemotherapy and instead focus aggressively on her quality of life.

“There was a peace that I saw that kind of came over my mother and my family once we kind of changed the approach and direction to her care,” Blake said.

So now, after 7-plus years of medical training, Blake has once again set out to learn how to provide this kind of peace to others.

He took the unconventional step of pursuing a Palliative Medicine fellowship at the University of Michigan.  It’s a fast growing medical specialty designed to relieve patient suffering.  Palliative Medicine providers act as medical consultants and are paid like other medical specialists.  

Blake now spends each day talking with patients, families, and other health care providers.

His goal is to answer, in a very personal way, the difficult questions that patients like Amy Berman have.  She was diagnosed with metastatic breast cancer two years ago, and faced the tough choice about whether to pursue chemotherapy that would not provide a cure.

“We need to know exactly what’s being done before it’s done to us," said Berman. "We need to know likely the course of events of the disease, we need to know what the treatments are going to be, we need to know what the treatments are going to cost, how they’ll make us feel in the short run, what’s the likely benefit in the long run.”

When Blake returns to his full-time emergency medicine career, he will face difficult questions from his colleagues about whether providing palliative care in the E.R. setting is feasible, especially when they are flooded with patients and time is at a premium.  

Blake says the E.R. is a great place to plant the palliative care seed, and there is plenty of opportunity to improve communication. “I try to educate my peers that our days are certainly busy and hectic but if we take that time, I believe outcomes will be better for our patients.”

- Dr. Nishant Sekaran, Michigan Radio Newsroom

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