Palliative care is specialized medical care for people with serious illnesses that focuses on reducing symptoms, pain and stress–whatever the diagnosis.
The goal is to improve quality of life for both patient and family.
Such care is provided by a team of doctors, nurses, social workers, chaplains and other specialists who work with the patient’s doctors.
Palliative care is an extra layer of support whereby the team can offer information and guidance for complex medical decisions.
It is appropriate at any age or stage in a serious illness and can be provided with curative treatment.
Parampal Singh Bhullar, MD., is here to explain how Greenville Health System's palliative care is here to help the whole family when one of your loved ones is suffering.
Selected Podcast
Palliative Care: Helping to Provide Relief From A Serious Illness
Featured Speaker:
Learn more about Parampal Singh Bhullar, MD
Parampal Singh Bhullar, MD
Parampal Singh Bhullar, MD., specialty is palliative care.Learn more about Parampal Singh Bhullar, MD
Transcription:
Melanie Cole (Host): Many people confuse hospice care and palliative care. However, the two are very different. My guest today is Dr. Parampal Bhullar. He's the medical director in the Division of Palliative Care at Greenville Health System. Welcome to the show, Dr. Bhullar. Tell us, what is palliative care and how does it differ from hospice care?
Dr. Parampal Bhullar (Guest): Okay, great. Thank you for having me with you. Palliative care is a specialized medical care for patients with serious illness. This type of care is focused on providing patients with relief from symptoms, pain, and stress of the serious illness, whatever the diagnosis. The goal is really to improve the quality of life for both patient and family and it is provided by a team of doctors, nurses, social workers, chaplains, and other specialists who work with the patient's other doctors to provide an extra layer of support--almost like a consultant team. Now, palliative care can be provided at any stage, any age, any serious illness, and the real difference between palliative and hospice is that palliative care can be provided along with curative treatment whereas hospice is a common benefit for patients who may have less than 6 months to live and it is not provided along with curative treatment. So, hospice is really an end-of-life specialty for the last 6 months of the life and palliative care is the specialty for the seriously ill patient, regardless of the time you might have. That's the big difference.
Melanie: So, it's a very multi-disciplinary type of care, palliative care, involving many people. What is it about? What is it like when you say it's side-along care for the seriously ill? What are you talking about?
Dr. Bhullar: Okay. So, what I am talking about is that seriously ill patient have problems in many dimensions and like right now, only about 10% of all people die of sudden death. 90% of people, they get sick, they get more sick, and then it's a small road towards the end of life. So, many patients are in the last few years of life and they have problems such as symptom management. They have multiple specialists involved in their care and they have their family members too busy with their work life. So, there are a lot of challenges for the seriously ill patient. How palliative helps is that it really engages the patient into what the purpose for the medical illness means for them and it engages all the medical doctors to almost distill down what the medical situation is, what are the options, what are the opinions and then goes back to patient's wishes. What does the patient want? How do they want to live? So, patients can have informed decision-making. That's mostly what the medical providers on the palliative care team do. The social worker is there for emotional support and counseling around serious illness and the chaplain is there for spiritual support and counseling. We also have a nurse coordinator in the palliative care team which is mainly so things don't fall through the cracks in our health care system for that seriously ill patient. It's really all about the seriously ill patient, their life and we adapt to the patient.
Melanie: So, if a person accepts palliative care, does that mean that they still can get, as you say, curative treatments if they're going through chemotherapy, radiation? Then, palliative care helps with the side effects from those treatments, but they can still get treatments to cure whatever it is?
Dr. Bhullar: Absolutely. For patients who are getting curative cancer treatment and have uncontrolled symptoms—pain or anything --our focus is really on optimal symptom management, working with the oncologist and avoiding too many hospitalizations from symptom management. So, yes, palliative works alongside curative treatment. That's not even for cancer patients but also all patients with heart problems, lung problems, neurological problems, patients with dementia.
Melanie: So, when somebody accepts palliative care, you mentioned spiritual care and counseling. So, do they work with each of these different departments? Nutrition, physical therapy, whatever it is that's involved, they work with each of those kinds of people to help with the symptom management?
Dr. Bhullar: Well, the palliative care team typically has a core team of a doctor, nurse practitioner, social worker, chaplain, nurse coordinator. Then, we have the other specialists we work with, like you said, nutritionists, physical therapy, occupational therapy, massage therapy and music therapy. So, whereas the medical part of the team looks at how to treat symptoms with medicines, we also look at the non-pharmacological, the non-medicine side of healing the patient. So, basically, we almost have like an integrative medicine type of approach to health care and we do that with our core team; assessing the patient and reaching out to whoever we need to reach out for that patient.
Melanie: Can family members be involved or receive palliative care, as well, and caregivers?
Dr. Bhullar: Well, you know palliative care looks at the patient and family as a unit. So, whenever we meet with the family, our next question is, “Tell us about the support system and who's the caregiver,” and we often meet with the caregiver. Do they have any caregiver burnout problem? Do they have enough support? So, we treat patient and family as a unit and we know quality of life for patient is always dependent on how things are going in their social life. So, yes, the patient's family is involved and we have often with our first meeting with the family is we call for a family meeting. We want to be with the patient, patient's family members and, before we meet with them, we check with all the specialists to make sure we have the medical information. The family is very, very much involved.
Melanie: Dr. Bhullar, does insurance pay for palliative care?
Dr. Bhullar: That's a good question. Insurance pays for the doctor in palliative care for billing. Let's say somebody's in the hospital and for any medical problems, the hospital bills or the primary care doctor bills, then the patient sends the regular bill to the insurance, so does the palliative care doctor or nurse practitioner. But, typically, our social worker, chaplain, RN coordinator, they shouldn't have to pay for that. It's almost a free service. So, most palliative care programs are subsidized by the hospital to benefit the seriously ill patient. They don't make money for the hospital and the health system does not want patients to pay for it, so they subsidize the program to improve the quality of life for their patients and families.
Melanie: How lovely. And can palliative care go along with hospice care at the end of life?
Dr. Bhullar: Well, when it comes time to hospice, palliative care basically does a hand off. Let's say they will take palliative care involved with a patient in the last few years of life along with curative treatment. Now, if the patient does decline and comes to the point where curative treatment is not an option and the patient wants to focus on just symptom management and the doctor says patient may have less than six months, then the social worker on the palliative care team will help that family find a good hospice to take care of them and it will almost be a hand off to a hospice.
Melanie: In just the last few minutes, Dr. Bhullar, tell us a little bit about your team at Greenville and the palliative care team and what they offer patients.
Dr. Bhullar: Okay. Greenville has had a palliative care team since the last 10 years or so. We did almost a redesign of the program two years ago, so we had a division of palliative care established in March of 2014 and before that, palliative care was provided here only by doctors and nurse practitioners. So, when we re-established palliative care here, we decided to do it in the right way. We decided to have an inter-professional approach. We hired a social worker, chaplain, and RN coordinator and right now, we have a big team at the Greenville Memorial Hospital in Greenville where we have five doctors on the team, three nurse practitioners, three social workers, three chaplains, and three RNs. So, Greenville Health System is supporting the needs of the seriously ill patient and family in a big way. We have a large presence at Greenville Memorial Hospital. We also have a half-a-day a week cancer center clinic for symptom management again for cancer patients. We also have a Saturday half-a-day a month clinic for the advanced lung disease patient. So, Greenville Health System has made big strides in in-patient palliative care over the last couple of years and now our focus is on out-patient palliative care. How can we help the patients in the community? How can we help them before they get to us in the hospital? How can we go provide some early palliative care, not late palliative care when they're already sick in the hospital?
Melanie: Thank you so much. We certainly applaud all the great work that you do for patients, Dr. Bhullar. You're listening to Inside Health with Greenville Health System. And for more information, you can go to ghs.org. That's ghs.org. This is Melanie Cole, thanks so much for listening.
Melanie Cole (Host): Many people confuse hospice care and palliative care. However, the two are very different. My guest today is Dr. Parampal Bhullar. He's the medical director in the Division of Palliative Care at Greenville Health System. Welcome to the show, Dr. Bhullar. Tell us, what is palliative care and how does it differ from hospice care?
Dr. Parampal Bhullar (Guest): Okay, great. Thank you for having me with you. Palliative care is a specialized medical care for patients with serious illness. This type of care is focused on providing patients with relief from symptoms, pain, and stress of the serious illness, whatever the diagnosis. The goal is really to improve the quality of life for both patient and family and it is provided by a team of doctors, nurses, social workers, chaplains, and other specialists who work with the patient's other doctors to provide an extra layer of support--almost like a consultant team. Now, palliative care can be provided at any stage, any age, any serious illness, and the real difference between palliative and hospice is that palliative care can be provided along with curative treatment whereas hospice is a common benefit for patients who may have less than 6 months to live and it is not provided along with curative treatment. So, hospice is really an end-of-life specialty for the last 6 months of the life and palliative care is the specialty for the seriously ill patient, regardless of the time you might have. That's the big difference.
Melanie: So, it's a very multi-disciplinary type of care, palliative care, involving many people. What is it about? What is it like when you say it's side-along care for the seriously ill? What are you talking about?
Dr. Bhullar: Okay. So, what I am talking about is that seriously ill patient have problems in many dimensions and like right now, only about 10% of all people die of sudden death. 90% of people, they get sick, they get more sick, and then it's a small road towards the end of life. So, many patients are in the last few years of life and they have problems such as symptom management. They have multiple specialists involved in their care and they have their family members too busy with their work life. So, there are a lot of challenges for the seriously ill patient. How palliative helps is that it really engages the patient into what the purpose for the medical illness means for them and it engages all the medical doctors to almost distill down what the medical situation is, what are the options, what are the opinions and then goes back to patient's wishes. What does the patient want? How do they want to live? So, patients can have informed decision-making. That's mostly what the medical providers on the palliative care team do. The social worker is there for emotional support and counseling around serious illness and the chaplain is there for spiritual support and counseling. We also have a nurse coordinator in the palliative care team which is mainly so things don't fall through the cracks in our health care system for that seriously ill patient. It's really all about the seriously ill patient, their life and we adapt to the patient.
Melanie: So, if a person accepts palliative care, does that mean that they still can get, as you say, curative treatments if they're going through chemotherapy, radiation? Then, palliative care helps with the side effects from those treatments, but they can still get treatments to cure whatever it is?
Dr. Bhullar: Absolutely. For patients who are getting curative cancer treatment and have uncontrolled symptoms—pain or anything --our focus is really on optimal symptom management, working with the oncologist and avoiding too many hospitalizations from symptom management. So, yes, palliative works alongside curative treatment. That's not even for cancer patients but also all patients with heart problems, lung problems, neurological problems, patients with dementia.
Melanie: So, when somebody accepts palliative care, you mentioned spiritual care and counseling. So, do they work with each of these different departments? Nutrition, physical therapy, whatever it is that's involved, they work with each of those kinds of people to help with the symptom management?
Dr. Bhullar: Well, the palliative care team typically has a core team of a doctor, nurse practitioner, social worker, chaplain, nurse coordinator. Then, we have the other specialists we work with, like you said, nutritionists, physical therapy, occupational therapy, massage therapy and music therapy. So, whereas the medical part of the team looks at how to treat symptoms with medicines, we also look at the non-pharmacological, the non-medicine side of healing the patient. So, basically, we almost have like an integrative medicine type of approach to health care and we do that with our core team; assessing the patient and reaching out to whoever we need to reach out for that patient.
Melanie: Can family members be involved or receive palliative care, as well, and caregivers?
Dr. Bhullar: Well, you know palliative care looks at the patient and family as a unit. So, whenever we meet with the family, our next question is, “Tell us about the support system and who's the caregiver,” and we often meet with the caregiver. Do they have any caregiver burnout problem? Do they have enough support? So, we treat patient and family as a unit and we know quality of life for patient is always dependent on how things are going in their social life. So, yes, the patient's family is involved and we have often with our first meeting with the family is we call for a family meeting. We want to be with the patient, patient's family members and, before we meet with them, we check with all the specialists to make sure we have the medical information. The family is very, very much involved.
Melanie: Dr. Bhullar, does insurance pay for palliative care?
Dr. Bhullar: That's a good question. Insurance pays for the doctor in palliative care for billing. Let's say somebody's in the hospital and for any medical problems, the hospital bills or the primary care doctor bills, then the patient sends the regular bill to the insurance, so does the palliative care doctor or nurse practitioner. But, typically, our social worker, chaplain, RN coordinator, they shouldn't have to pay for that. It's almost a free service. So, most palliative care programs are subsidized by the hospital to benefit the seriously ill patient. They don't make money for the hospital and the health system does not want patients to pay for it, so they subsidize the program to improve the quality of life for their patients and families.
Melanie: How lovely. And can palliative care go along with hospice care at the end of life?
Dr. Bhullar: Well, when it comes time to hospice, palliative care basically does a hand off. Let's say they will take palliative care involved with a patient in the last few years of life along with curative treatment. Now, if the patient does decline and comes to the point where curative treatment is not an option and the patient wants to focus on just symptom management and the doctor says patient may have less than six months, then the social worker on the palliative care team will help that family find a good hospice to take care of them and it will almost be a hand off to a hospice.
Melanie: In just the last few minutes, Dr. Bhullar, tell us a little bit about your team at Greenville and the palliative care team and what they offer patients.
Dr. Bhullar: Okay. Greenville has had a palliative care team since the last 10 years or so. We did almost a redesign of the program two years ago, so we had a division of palliative care established in March of 2014 and before that, palliative care was provided here only by doctors and nurse practitioners. So, when we re-established palliative care here, we decided to do it in the right way. We decided to have an inter-professional approach. We hired a social worker, chaplain, and RN coordinator and right now, we have a big team at the Greenville Memorial Hospital in Greenville where we have five doctors on the team, three nurse practitioners, three social workers, three chaplains, and three RNs. So, Greenville Health System is supporting the needs of the seriously ill patient and family in a big way. We have a large presence at Greenville Memorial Hospital. We also have a half-a-day a week cancer center clinic for symptom management again for cancer patients. We also have a Saturday half-a-day a month clinic for the advanced lung disease patient. So, Greenville Health System has made big strides in in-patient palliative care over the last couple of years and now our focus is on out-patient palliative care. How can we help the patients in the community? How can we help them before they get to us in the hospital? How can we go provide some early palliative care, not late palliative care when they're already sick in the hospital?
Melanie: Thank you so much. We certainly applaud all the great work that you do for patients, Dr. Bhullar. You're listening to Inside Health with Greenville Health System. And for more information, you can go to ghs.org. That's ghs.org. This is Melanie Cole, thanks so much for listening.
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