Request to Join
has invited you to join this group
Beginning January 5, 2021, Rotation Prep will no longer be available as part of an individual or institutional subscription to NEJM or NEJM Journal Watch. Learn More
Palliative Care is a relatively new field of medicine born out of the hospice movement.
The Center to Advance Palliative Care (CAPC) defines palliative care as “specialized medical care for people living with a serious illness. This type of care is focused on providing relief from the symptoms and stress of the illness. The goal is to improve quality of life for both the patient and the family.” Palliative care is provided by a specially trained team. Palliative care specialists work together with a patient’s other clinicians to provide an extra layer of support. Palliative care is based on the needs of the patient, not on the patient’s prognosis. It is appropriate at any age and at any point in a serious illness and can be delivered at the same time as curative treatment.
The World Health Organization (WHO) defines palliative care as “an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.” They add that palliative care:
The palliative care rotation may differ from other rotations. Most palliative care services work as an interdisciplinary team that may include physicians, nurse practitioners, physician assistants, social workers, and chaplains. This diverse team can provide whole-person care, which is crucial for patients with serious illness. While medical clinicians may focus more on the medical aspects of care and the social workers and chaplains more on the psychosocial and spiritual aspects, all team members practice transdisciplinary care such that the medical clinician will discuss psychosocial and spiritual issues and the social worker or chaplain may assess pain or nausea. Referring teams call palliative care consults for many reasons, including symptom management, goals of care, or end-of-life care. Another aspect that may feel new is the amount of suffering that palliative care teams witness on a daily basis. It is normal to find this rotation emotional or tiring in a different way. You will also learn coping strategies that palliative care teams implement, including reflection on patient interactions, mutual support of team members, and memorializing each patient that dies, among others.
This guide covers the following topics:
Other topics related to palliative care are covered in the following rotation guides:
For a brief history of palliative care, click here.
This rotation guide was developed by a collaborative team of contributors including:
Writers: Patrick W. Malecha, MD; Erin Scott, MD; Andrew Lawton, MD; Kathleen Doyle, MD
Section Expert: Kathleen Doyle, MD
Senior Editor: Ole-Petter Hamnvik, MB BCh BAO, MMSc
Last updated: December 2020
Kathleen Doyle, MD received her undergraduate degree from Georgetown University and her medical degree from University of Connecticut. She completed her internal medicine residency at Brown University in Providence, RI. She stayed on at Brown for an additional year to complete a year as chief resident and then enrolled in the Harvard palliative medicine fellowship program in 2009. She joined the Massachusetts General Hospital palliative care service as an attending in September 2010.
The pandemic has revealed the unambiguous impact of health disparities on morbidity and mortality from Covid-19 in disadvantaged populations. Patients with chronic health conditions and Black, Indigenous and People of Color (BIPOC) communities have...
Ranking residency programs is an important conclusion to the residency application process, particularly this year with all of the challenges presented by COVID-19. The virtual interview season will help you identify programs that fit your goals, interests, and...
We have invited the residents and faculty from the Mount Sinai Morningside – West, Internal Medicine Residency Program to engage in a journal club discussion about the NEJM article, "Bupropion and Naltrexone in Methamphetamine Use Disorder.” The authors will be...
Communication is key in all relationships. Effective and compassionate communication by physicians and other health care providers has been demonstrated to improve clinical outcomes, treatment adherence, patient satisfaction, and to reduce malpractice claims. For health care providers...
Although every resident develops his or her own style for each of these roles, the following practical strategies were discussed in a NEJM Resident 360 discussion (How to Lead a Team on the Wards: The Art to Being an Effective Resident).
For many medical trainees, transitioning from having a question for a research project to taking the next steps is difficult. Finding an appropriate mentor, getting ethics approval, collecting data, performing analyses, and writing up a project for publication are particularly hard when added to the pressures and stresses of medical school or residency.