Providing Relief From Pain

Dr. Daniel Fischberg
By Daniel Fischberg
Interviewed by Lisa Asato
Wednesday - August 01, 2007
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Dr. Daniel Fischberg discusses palliative care at Queen’s Medical Center
Dr. Daniel Fischberg discusses palliative care at Queen’s Medical Center

What is palliative care?

Palliative care is the newest subspecialty in medicine. It focuses on the prevention and relief of pain, other symptoms and distress for people living with a serious illness. ... The founders of the palliative-care movement very much believed in looking at patients’ suffering in the physical, emotional, social and spiritual dimensions.

What’s the difference between hospice and palliative care?

Palliative care grew out of the hospice movement, which is for people who are in their last six months of life. ... Typically when people are electing hospice they’re choosing to focus exclusively on their comfort. ... The focus on quality of life, on whole-patient care, on the patient and family as a treatment unit - those are all things that palliative care learned directly from hospice. But palliative care applies those things to people who are still receiving active treatments for their illness who are still pursuing life-prolonging treatment and may have a longer prognosis than six months.

What are the main reasons people come to see you?

I want to clarify, we don’t have an outpatient program so people can’t just call and make an appointment to see me. Our program serves patients who are hospitalized here. ... It’s one of our goals in the near future to develop an outpatient program.

How many patients does your department see?

We’re requested to see over 1,200 patients a year. Ninety percent of those patients have a pain problem, about 15 percent will have a problem with another symptom, for example, nausea, shortness of breath. For about 20 percent we’re asked to help to provide additional support in a plan of care. That might mean facilitating communication with the family, which is a big role for us, that might be connecting people with resources outside the hospital, or serving as an additional psychosocial support.

Do they elect to see you or are they referred?

Both. Because there’s so little knowledge about palliative care ... people don’t know enough to ask.

The actual request for our involvement always comes with an order from the attending physician, but the idea of the involvement may come from another nurse or doctor. I look forward to the day when it comes from the families. When they know enough to say, “My mom has pain. I would like a palliative-care doctor to come by.” And hopefully this article will be a step toward that some day.

What do you do for them?

First thing is to listen. ... We often ask a lot of questions to learn what is going on in someone’s life and do a head-to-toe assessment of what other kinds of problems they’re having: Are they having problems with their appetite, how is their mood, are they having a lot of nervousness, are they sleeping well? Also we would like to know how they’re coping and to know something about their spirituality. We like to know what sort of stresses their family might be going through. We like to learn how they like to get information. ... Once we do a comprehensive assessment obviously we need to pay attention to whatever the attending doctor - if they call us for pain that’s what we’ll focus on - but we identify other problems based on that active listening. We’ll make recommendations for other problems, too.

Anything else?

Sometimes people need assistance with extra resources outside the hospital so members of the team, particularly our social workers, are very knowledgeable about resources in the community, and I have to add that Hawaii is actually ahead of the curve in some very kind of new, novel resources that can be brought to bear for people who are living with serious illness. ... So people leaving the hospital we try to build a plan of care for them to continue once they leave the hospital.

What is the state of palliative care in Hawaii and the nation?

We’ve got more palliative-medicine certified doctors per capita than any other state. We’re well ahead of the country. ... Hawaii has also been very progressive in terms of developing services or paying for palliative-care services and finding creative ways to meet the need of their the people they cover.

Is this covered by insurance?

Yeah, typically.

What is the future of palliative care?

It’s moving toward increasing availability and moving it upstream. What I mean by “upstream” is so often patients are referred very late in life for palliative-care services, and the idea is the services might be appropriate at the time they are first diagnosed with a serious illness. Palliative care might play a small part at that time, but rather than waiting and referring a patient to hospice at the end of the diagnosis, palliative care (can intervene earlier) so patients can optimize both quality and quantity of life.

How large is your staff?

Seven. We’re an interdisciplinary team. That means I’m a doctor and I work with five nurse colleagues, mostly advanced-practice nurses, and a social worker as a team of seven. No one doctor, nurse, social worker, chaplain can comprehensively manage all the physical, emotional, spiritual and social domains involved.

How can people learn more?

Two websites I refer people to - one is local and is - and that is a wonderful site where people have local information about palliative care. ... Another site where people can get more information is called

Can you say more about Kokua Mau?

Kokua Mau is our award-winning statewide organization dedicated to promoting hospice and palliative care, and if I had to pick one resource for people in the community it would be the Kokua Mau website. If you are in a hospital you should ask the hospital if they have a program. If you’re at Queen’s the answer will be “yes.”

This information is provided as educational and is not intended as a substitute for consultation with a physician. For questions, consult your physician or call Kokua Mau at 585-9977.

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