Path to Palliative Care: One Physician’s Journey

The Day-to-Day and Rewarding Benefits of Providing Comfort Care

Placing a check in the box labeled “number 15 – build a garden,” Norma took a step back and marveled at the huge plot of her backyard that would soon be filled with all of the flowers and herbs that she could grow in southern New Jersey. Looking back at her notebook, the next item on her bucket list read “number 16 – get a tattoo.” At 84 years old, she was still determined to live life to the fullest.

Meanwhile, Bob just hopped on what felt like his hundredth flight in one month. Exhausted and scared, he was determined to keep going. Just 55 years old with a family at home, Bob flew all over the country to receive treatments, undergo surgeries and keep fighting.

The common factor between the two: terminal cancer.

Dr. David Buxton, Medical Director of Palliative Care for ApolloMD, was completing his second year of medical school at the time his Grandmother Norma and Uncle Bob received their cancer diagnoses.

“I watched two family members that were both diagnosed with a terminal illness choose to approach medical care in very different ways,” said Buxton. “One wanted to limit medical interventions and focus on what time was left and the other wanted to seek out all treatment options and fight until the end. These realities of how people chose to face cancer struck me and that is when I decided I would pursue a fellowship in palliative care.”

A Day in the Life

Now, a practicing palliative care physician at Chippenham and Johnston-Wills Hospital in Richmond, Virginia, Dr. Buxton is proud to provide patients who have complex life limiting diagnoses with an additional layer of care.

“Patients may come in with a cancer diagnosis, congestive heart failure, dementia or multiple different diagnoses that have placed them in the hospital three to four times within one month,” said Buxton. “Every day and every patient in palliative care is different, but most of the time these patients and their families know something is changing- physically, psychologically and spiritually.”

Dr. Buxton and his team serve largely as a consult service, picking up cases in all stages of a patient’s diagnosis or treatment plan. Consults address symptom management like pain or nausea, prognostication, setting goals of care and providing support to patients and their families. In the best case scenarios, patients are seen on initial diagnosis to allow his team to get to know them as people before they become sick and depleted from diseases and treatment side effects. “We always say on our team, we hope for the best but also prepare for the worst.”

Benefits for All

According to Buxton, palliative care offers a benefit on multiple levels. For patients, there is more access to someone who can help treat symptoms that interfere with them enjoying life as well as someone to make sure their goals are at the forefront of treatment.

Palliative care is unlike any other specialty because family members also reap the benefits. Dr. Buxton is there to check-in with the family, see how they are coping and offer psychological counseling. With the high-risk of developing anxiety, depression or substance abuse after a loved one dies, it is imperative to Buxton that the family is also taken care of.

Hospitalists and other physicians benefit from palliative care by having a specialized physician to spend time talking with the patients and their families about treatment goals and someone with expertise in symptom and pain management.

From a healthcare system perspective, patient’s length of stay in the hospital can be decreased to allow other patients access to inpatient care. For example, seriously ill patients can experience a longer hospital stay than most patients because there is not a specialized physician who can spend long periods of time to meet with the family members and provide difficult updates, coordinate other medical specialists or explain when hospice may be the right decision. Palliative care physicians are able to provide these services to patients.

“About 80 percent of the population report a preference to die at home, but the reality is about 60 percent die in the hospital,” said Buxton. “A shared goal of all palliative care providers is to know when to get patients home to pass comfortably and peacefully. This is a benefit for all – patients, families, hospitalists and the health system as a whole.”

Dr. Buxton also believes he benefits on a personal level by practicing palliative medicine.

“This specialty of medicine is influential not only in my practice, but in my life,” said Buxton. “I am appreciative of all of the small things and lucky to know I have more time in life- something most of my patients do not have. My goal at the end of the day is to make sure my patients can live the last chapter of their lives with their loved ones and as comfortably as possible.”

National Hospice and Palliative Care Month

This November, as we recognize National Hospice and Palliative Care Month, it is important for not only patients to utilize the services of palliative care but other physicians and hospitalists to refer their patients to these services. Physicians should educate their patients on what palliative care can offer and recognize that it is not just for patients dying such as hospice, but can be implemented at any point during a patient’s diagnosis.

“Most patients and their families who utilize our services come to us and say ‘we wish we were referred to you sooner’ or ‘we wish we had come to you when we first received our diagnosis,” said Buxton. “Studies have even shown when patients receive palliative care they not only have a better quality of life but live longer. We are here to accompany patients and their families during their toughest moments in life.”

Dr. David Buxton received his bachelor’s degree from Emory University in Atlanta, Ga., and his medical degree from Virginia Commonwealth University in Richmond, Va. He completed his adult psychiatry residency at Brown University Department of Psychiatry and Human Behavior. Dr. Buxton then completed his child and adolescent psychiatry fellowship at Harvard University- Massachusetts General Hospital. He then completed a Palliative Care fellowship at Harvard University – Massachusetts General Hospital/Dana Farber, making him the first child psychiatrist in the country to complete a palliative care fellowship.

Board certified by the American Board of Psychiatry and Neurology, Dr. Buxton currently serves as the Medical Director of Palliative Care for ApolloMD, Medical Director of Palliative Care at Chippenham-Johnston-Willis Hospital, Chief Medical Officer of Behavior Health for MYidealDOCTOR and Chief Executive Officer of the Center for Palliative Psychiatry. He is a clinical assistant professor at Virginia Commonwealth University and has presented on palliative care and psychiatry at local, national and international conferences.

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