The pathway of palliative care – both historically and looking ahead – was the featured theme at the ninth annual Robert Leffert, MD, Memorial Lecture on Nov. 12. Presented by the MGH Division of Palliative Care and Geriatric Medicine, the lecture honors Leffert – who served as chief of the MGH Department of Rehabilitation Medicine and the MGH Surgical Upper Extremity Rehabilitation Unit – and the compassionate care he received from the division before his death in 2008.
“Anyone who has ever had the misfortune – but natural human experience – of becoming a patient and facing a disease knows how very difficult the process can be,” said Lee Schwamm, MD, division chief of Stroke Services, executive vice chair of the Neurology Department and Leffert’s son-in-law. “Having someone alongside you throughout is very meangful.”
The keynote speaker was Rob George, MD, medical director of St. Christopher’s Hospice in London, who spoke about the HIV epidemic in 1987 and how palliative care has changed in the ensuing years during his talk, “Reflections on Palliative Care, Lessons Learned from St. Christopher’s Hospice.” George has since pioneered HIV and non-cancer palliative care and has worked in all clinical palliative care settings – teaching hospitals, the National Health Service and voluntary hospices. His particular interests lie in the philosophy and ethics of care.
“If you really want to know what palliative care is about, it’s about rebundling people from pathology back into personhood,” George said.“The goal of medicine is to live lives well, not die deaths badly.”
George reflected on the history of palliative care through the decades, discussed the many dilemmas facing health care today and the need to shift the language of hope, harm and care. “We need to use the language of hope differently,” he said. “Hope does not mean curability. Hope is the idea that things can be different than the way they are now.”Despite the common present-day focus on test-after-test, curability and continued care, “clinicians – when it comes down to it – are just like everyone else,” said George. “When faced with a disease, the first things they will think of won’t be what the scans show or what tests to do. The first things they’ll think of will be of their families, their children, the effect this will have on their lives. We need to work to get back to that basis.”