Dr. Alan Goldblatt could have continued to practice general internal medicine but his life’s path took him to palliative care. And that’s good news for this community.
Goldblatt is the medical director at the Senior Healthcare Center at Crown Pointe, He watched in the early 1990s as his patients aged, and he became more interested in geriatric medicine. He was not happy with what he saw.
“Patients were reaching a certain point and being institutionalized,” he said. “It was not compatible with what I considered good medicine. I started taking care of them, and I guess I became an activist.”
As a result, he became an expert, and as the concept of palliative care grew, his passion for treating patients this way increased.
“It’s very simply about making patients feel better,” he said. “There are many different definitions of palliative care. For me it is an interdisciplinary field in medicine designed to deal with quality of life issues for patients with progressive illness. We are concerned with the global state of the patient – physical, psychological, social, even spiritual.”
One thing palliative care is not, says Goldblatt, is a replacement for curative measures. It’s also not hospice care. Instead it is a part of a continuum.
“It can be provided in addition to curative methods like chemotherapy or when you are dealing with end-stage lung disease or end stage heart failure for example,” he said. “It can also be part of the home care and can be integrated with hospice if and when that’s advisable. It is not used instead of hospice but in cooperation with hospice.”
For palliative care to be effective, it needs to be part of a team approach including the patient, family members, other physicians and anyone else involved in the patient’s care.
“Patients begin to see, and are often the first to see, that procedures and tests are less and less likely to make a difference in how they feel,” said Goldblatt. “As doctors, we are trained to cure. But patients will reach a point where they want doctors to focus on the symptoms. Most patients don’t know this option exists, or they mistake it for hospice care. Family members have to be clear to doctors. They have to advocate for the patient.”
And there are often misunderstandings of what constitutes palliative care. As an example, Goldblatt talks about an 89-year-old patient who is lucid, mobile and has good family support. But she has horrible pain from arthritis.
“We are looking at palliative hip replacement,” he said. “There are risks to the procedure. While it appears to be aggressive, it really is designed to reduce pain.”
Palliative care can be done at home or in the hospital. It can even start in ICU or the emergency room. It is all about looking at the situation and making the best decision for the patient, says Goldblatt.
“The primary purpose is to see the patient as a whole person,” he said. “As a doctor, I sit with someone at the end and discuss what’s important to them. It’s an extremely rewarding part of my practice. It’s a difficult conversation. It’s rewarding – not in dollars and cents and time but in other ways. It elevates a person, and it is a component of healing – even among dying people.”
