Palliative Care, a Different Voice in Healthcare: Timothy Ihrig at TEDxDesMoines
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Palliative Care, a Different Voice in Healthcare: Timothy Ihrig at TEDxDesMoines

Translator: Camille Martínez
Reviewer: Ivana Korom Thank you very much. I am a palliative care physician and I would like to talk to you
today about health care. I’d like to talk to you
about the health and care of the most vulnerable
population in our country — those people dealing with the most
complex serious health issues. I’d like to talk to you
about economics as well. And the intersection of these two
should scare the hell out of you — it scares the hell out of me. I’d also like to talk to you
about palliative medicine: a paradigm of care for this population,
grounded in what they value. Patient-centric care based on their values that helps this population
live better and longer. It’s a care model that tells the truth and engages one-on-one and meets people where they’re at. I’d like to start by telling the story
of my very first patient. It was my first day as a physician, with the long white coat … I stumbled into the hospital and right away there’s a gentleman,
Harold, 68 years old, came to the emergency department. He had had headaches for about six weeks that got worse and worse
and worse and worse. Evaluation revealed he had cancer
that had spread to his brain. The attending physician directed me
to go share with Harold and his family the diagnosis, the prognosis
and options of care. Five hours into my new career, I did the only thing I knew how. I walked in, sat down, took Harold’s hand, took his wife’s hand and just breathed. He said, “It’s not good
news is it, sonny?” I said, “No.” And so we talked
and we listened and we shared. And after a while I said, “Harold, what is it
that has meaning to you? What is it that you hold sacred?” And he said, “My family.” I said, “What do you want to do?” He slapped me on the knee
and said, “I want to go fishing.” I said, “That, I know how to do.” Harold went fishing the next day. He died a week later. As I’ve gone through
my training in my career, I think back to Harold. And I think that this is a conversation that happens far too infrequently. And it’s a conversation
that had led us to crisis, to the biggest threat
to the American way of life today, which is health care expenditures. So what do we know? We know that
this population, the most ill, takes up 15 percent
of the gross domestic product — nearly 2.3 trillion dollars. So the sickest 15 percent
take up 15 percent of the GDP. If we extrapolate this out
over the next two decades with the growth of baby boomers, at this rate it is 60 percent of the GDP. Sixty percent of the gross
domestic product of the United States of America — it has very little to do
with health care at that point. It has to do with a gallon of milk, with college tuition. It has to do with
every thing that we value and every thing that we know presently. It has at stake the free-market
economy and capitalism of the United States of America. Let’s forget all the statistics
for a minute, forget the numbers. Let’s talk about the value we get
for all these dollars we spend. Well, the Dartmouth Atlas,
about six years ago, looked at every dollar
spent by Medicare — generally this population. We found that those patients who have
the highest per capita expenditures had the highest suffering,
pain, depression. And, more often than not, they die sooner. How can this be? We live in the United States, it has the greatest health care
system on the planet. We spend 10 times more on these patients than the second-leading
country in the world. That doesn’t make sense. But what we know is, out of the top 50 countries on the planet with organized health care systems, we rank 37th. Former Eastern Bloc countries
and sub-Saharan African countries rank higher than us
as far as quality and value. Something I experience
every day in my practice, and I’m sure, something many of you
on your own journeys have experienced: more is not more. Those individuals who had more tests, more bells, more whistles, more chemotherapy,
more surgery, more whatever — the more that we do to someone, it decreases the quality of their life. And it shortens it, most often. So what are we going to do about this? What are we doing about this? And why is this so? The grim reality, ladies and gentlemen, is that we, the health care industry —
long white-coat physicians — are stealing from you. Stealing from you the opportunity to choose how you want to live your lives in the context of whatever disease it is. We focus on disease
and pathology and surgery and pharmacology. We miss the human being. How can we treat this without understanding this? We do things to this; we need to do things for this. The triple aim of healthcare: one, improve patient experience. Two, improve the population health. Three, decrease per capita expenditure
across a continuum. Our group, palliative care, in 2012, working with
the sickest of the sick — cancer, heart disease, lung disease, renal disease, dementia — how did we improve patient experience? “I want to be at home, Doc.” “OK, we’ll bring the care to you.” Quality of life, enhanced. Think about the human being. Two: population health. How did we look
at this population differently, and engage with them
at a different level, a deeper level, and connect to a broader sense
of the human condition than my own? How do we manage this group, so that of our outpatient population, 94 percent, in 2012,
never had to go to the hospital? Not because they couldn’t. But they didn’t have to. We brought the care to them. We maintained their value, their quality. Number three: per capita expenditures. For this population, that today is 2.3 trillion dollars
and in 20 years is 60 percent of the GDP, we reduced health care expenditures
by nearly 70 percent. They got more of what they wanted
based on their values, lived better and are living longer, for two-thirds less money. While Harold’s time was limited, palliative care’s is not. Palliative care is a paradigm
from diagnosis through the end of life. The hours, weeks, months, years, across a continuum — with treatment, without treatment. Meet Christine. Stage III cervical cancer, so, metastatic cancer
that started in her cervix, spread throughout her body. She’s in her 50s and she is living. This is not about end of life, this is about life. This is not just about the elderly, this is about people. This is Richard. End-stage lung disease. “Richard, what is it
that you hold sacred?” “My kids, my wife and my Harley.” (Laughter) “Alright! I can’t drive you around on it
because I can barely pedal a bicycle, but let’s see what we can do.” Richard came to me, and he was in rough shape. He had this little voice telling him that maybe his time was weeks to months. And then we just talked. And I listened and tried to hear — big difference. Use these in proportion to this. I said, “Alright, let’s take it
one day at a time,” like we do in every
other chapter of our life. And we have met Richard
where Richard’s at day-to-day. And it’s a phone call or two a week, but he’s thriving in the context
of end-stage lung disease. Now, palliative medicine is not
just for the elderly, it is not just for the middle-aged. It is for everyone. Meet my friend Jonathan. We have the honor and pleasure of Jonathan and his father
joining us here today. Jonathan is in his 20s,
and I met him several years ago. He was dealing with
metastatic testicular cancer, spread to his brain. He had a stroke, he had brain surgery, radiation, chemotherapy. Upon meeting him and his family, he was a couple of weeks away
from a bone marrow transplant, and in listening and engaging, they said, “Help us
understand — what is cancer?” How did we get this far without understanding
what we’re dealing with? How did we get this far
without empowering somebody to know what it is they’re dealing with, and then taking the next step and engaging
in who they are as human beings to know if that is what we should do? Lord knows we can do
any kind of thing to you. But should we? And don’t take my word for it. All the evidence that is related
to palliative care these days demonstrates with absolute certainty
people live better and live longer. There was a seminal article
out of the New England Journal of Medicine in 2010. A study done at Harvard
by friends of mine, colleagues. End-stage lung cancer: one group with palliative care, a similar group without. The group with palliative care
reported less pain, less depression. They needed fewer hospitalizations. And, ladies and gentlemen, they lived three to six months longer. If palliative care were a cancer drug, every cancer doctor on the planet
would write a prescription for it. Why don’t they? Again, because we goofy,
long white-coat physicians are trained and of the mantra
of dealing with this, not with this. This is a space that we will
all come to at some point. But this conversation today
is not about dying, it is about living. Living based on our values, what we find sacred and how we want to write
the chapters of our lives, whether it’s the last or the last five. What we know, what we have proven, is that this conversation
needs to happen today — not next week, not next year. What is at stake is our lives today and the lives of us as we get older and the lives of our children
and our grandchildren. Not just in that hospital room or on the couch at home, but everywhere we go
and everything we see. Palliative medicine is the answer
to engage with human beings, to change the journey
that we will all face, and change it for the better. To my colleagues, to my patients, to my government, to all human beings, I ask that we stand and we
shout and we demand the best care possible, so that we can live better today and ensure a better life tomorrow. We need to shift today so that we can live tomorrow. Thank you very much. (Applause)

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20 thoughts on “Palliative Care, a Different Voice in Healthcare: Timothy Ihrig at TEDxDesMoines

  1. Exceptional talk, Tim! I feel honored to know you and proud that you are raising these issues that are important to all of us.

  2. Thank you Tim – I am honoured to be connected to you via twitter – which was my motivation (from lurking on  #hpm tweetchat) to learn more – as a layperson – about palliative care. The result: and a TEDtalk: Exit Laughing.

  3. Thank you Dr. Timothy….. but still you didn't mention a bit about the definition of palliative care and how exactly it can be used to relieve pain and stress…. is it only psychological or it includes pharmacological and interventional techniques. Thanks again for your nice lecture😊

  4. I believe the same but many of us around me believe that palliative care is for end of life which Dr, Timothy has explained very clear that palliative care start from the diagnosis and ends with patient's life. Great…….

  5. I believe I am facing this and I am at peace with what will be. How do I bring this up with my adult children who live in three different. They have an idea something is happening how do I bring the topic up? I want to leave this life in peace with no extensive care & as little drama as possible. I'll check back.

  6. My Grandfather died on Tuesday. He was 96 years-old and had never been sick a day in his life. Seriously, the worst thing he had was a hernia from lifting my grandmother several years ago (before he had to put her in a nursing home) and surgery to remove gallstones. He still drove everyday and kept busy playing golf. He had fought in WWII and ran a successful business for many years. On Tuesday, he was sitting talking to my aunt and said all of the sudden that he didn't feel good. He stood up and fell down to the ground dead. That quick. I seriously thought he was going to live past 100. I was absolutely shocked to say the least. Honestly, I am still having a hard time wrapping my mind around it. I understand that a lot of people don't understand why I am upset or shocked that a 96 year-old died, but they just don't know my Grandfather! I do find comfort in knowing that since everyone has to die, his was quick with as little suffering as possible. I am thankful that he didn't languish in a nursing home like my grandmother did for years before she died. She died 2 years ago. He was her caretaker until he physically couldn't keep lifting her anymore. He visited her every single day sometimes twice a day when she was in the nursing home even though she hadn't known who he was in years. Selfishly, I wish I could have said goodbye, but I find peace and strength knowing that he did not suffer and that they are together again!

  7. Embroider I pulled this video up because someone asked me if we looked into palliative care for my father. I had no idea what it was and pulled this video up. I'm so sorry to say I still don't quite know what it is. What's the difference between palliative care and hospice? I guess I will watch more videos

  8. I think palliative care doctors are ok as long as they don't try to force their will on patients. If a patient wants to take a vial of sodium barbitol that will shut down the body, then they should be given that choice.

  9. i have Lou Gehrig's/ALS which is terminal. He never mentions it. ALOT of health professionals have never heard of it. hmmmmmm

  10. Dr. Ihrig, you might want to read Stephen Jenkinson’s book, “Die Wise.” He headed the home-based palliative care department in Canada’s largest hospital for five years. I am currently in palliative care in a Kaiser facility in California. Good title, yes, it’s about living, but also about some acceptance of the limits of being a human and both living a life informed by death as to it’s preciousness and ending a life knowing that life requires an ending just as it requires a beginning.

  11. I have felt like I am part of a thrown away segment of the disabled population. I am 57. And therein is my failure in receiving proper and necessary health care. I have thru my Dr and even my ins co BCBS, been identified as a person who needs home health care. However I am not a senior nor am I ready for a nursing home. The diagnosis of CAD on top of uncontrolled diabetes 2, HBP, Familial Hypercholesterolemia and 7 family members before me who have died early of these same diseases. But I have the added bonus of Osteoarthritis and other damage to my spine which renders me unable to walk more than a few hundred steps per day. I am told by Medicare that I don't need help unless I pay for it myself. I live on my disability and that doesn't leave enough to pay for home health care. I can't even obtain a ride to a Dr. I wonder if palliative care could be for me?

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