Palliative Care: Treating the Whole Patient

Peter L. Slavin and David F. Torchiana explain how focusing on more than just curing a disease can greatly improve a person's quality of life.

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Etched in stone along the main corridor of Massachusetts General Hospital are the words: “The secret of care of the patient is caring for the patient.” Delivered in a Harvard Medical School lecture in October 1925 by Francis Peabody, an MGH trainee who practiced at Boston City Hospital, that epigram might serve as a tagline for palliative care.

Photo by Julia Bishop, Courtesy of Massachusetts General Hospital

1917 wicker wheelchair discovered in hospital storage

In this issue of Proto, we examine this often misunderstood discipline. Unlike hospice, which aims to make a patient comfortable at the end of life, palliative care focuses on helping patients with a serious disease live as well as possible; it provides relief from pain and other physical symptoms as well as from depression, fear, anxiety and a range of nonmedical issues.

Palliative care specialists are trained to help patients understand treatment options and to seize what control they can over the course of a disease. They stand with the patient who elects to undergo yet another tedious, exhausting therapy just as they stand with the patient who says “enough.”

A year ago, a study by Jennifer Temel and Vicki Jackson from MGH showed, rather remarkably, that patients with advanced lung cancer who received palliative care soon after diagnosis not only had a better quality of life but also lived significantly longer. Future studies may demonstrate that palliative care can save money by reducing unnecessary hospital admissions, futile diagnostic and treatment interventions, and nonbeneficial intensive care.

Yet even now, some physicians resist the idea of palliative care. They are taught to treat and to cure, to do whatever it takes to give a patient a chance, to offer hope. Calling in the palliative care team may feel like giving up the good fight. But in reality, providers in this specialty are right there in the patient’s corner, round after round.

In his oft-quoted 1925 lecture, Peabody encouraged students to cherish the human side of medicine. “The treatment of a disease may be entirely impersonal; the care of a patient must be completely personal,” the physician counseled. A true clinical picture, he said, “is an impressionistic painting of the patient surrounded by his home, his work, his relations, his friends, his joys, sorrows, hopes and fears.” Peabody would be pleased to know that the prescription he wrote nearly a century ago remains ever more relevant—and embodied in a specialty known as palliative care.