The human element

November 15, 2021

Sometimes we may feel weak and want to be helped. Other times we may feel broken and want to be fixed. But what about the times when we do not feel weak or broken but still need support? Palliative care addresses the details of life that can be challenging as we cope with larger aspects or ramifications of a diagnosis. As part of our series on hospice and palliative care this month, this article focuses on a foundational concept of palliative care: service and shared humanity. A common refrain that can be overheard in many conversations with our clinical teams is, “Our primary care is palliative care too.” While hospice is typically defined as a specific type of palliative care, it is not as common to see primary care included in the definition.

Often palliative care is defined in the context of providing support and attending to the symptom management of a patient regarding a specific diagnosis.  This is the case when a formal palliative care team is brought in to serve the needs of a patient due to the additional strain of a difficult illness. But the needs of a patient are the focus of primary care too. This is why we refer to our services as a ‘continuum of care’, rather than as three distinct services where primary care, palliative care and hospice are each separate.

Going deeper, we turn to the ideas of physician Rachel Remen, “Helping, fixing and serving represent three different ways of seeing life,” she says. “When you help, you see life as weak. When you fix, you see life as broken. When you serve, you see life as whole. Fixing and helping may be the work of the ego, and service the work of the soul. Fixing and helping create a distance between people, but we cannot serve at a distance. We can only serve that to which we are profoundly connected.”

In the essay (linked below), Remen relates two stories that bring the distinction into sharp focus. One is of an emergency room doctor who initially saw his work as a challenge and his reward as successful outcomes. This changed during a particular case where delivering a baby profoundly connected him to the lives of his patients. His perspective changed from one where he participated in unequal exchanges to one where his humanity was able to serve that of the people who came to him as patients in a mutual and equal collaboration. The second story is a  personal account by Remen describing the difficulty and even shame she felt as a young woman learning to change her appliance after having a large section of her intestines removed. The nurse who finally taught her the trick, did so by engaging with Remen on a human, rather than a purely clinical level.  

Understanding this connection – that health care is about personal and human connection and the  a cornerstone of good health care –  helps explain why we call our services a continuum of care and also why you might overhear a member of Housecall Providers staff say. “All our primary care is palliative care too.” Read Dr. Remen’s essay to be inspired by her stories and her ideas:

https://www.mentalhealthsf.org/wp-content/uploads/2020/01/HelpingFixingServing-by-Rachel-Remen.pdf

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