Celebrated Physician: Clint Pettit, MD

Why Palliative Care?

In recent years, more and more patients facing a serious illness have turned to the complimentary discipline of palliative care to help cope with the physical and emotional demands of their condition. Because communication is critical in assisting patients and loved ones through what are often difficult treatment decisions, palliative care is the ideal discipline for MedStar Washington Hospital Center attending physician Clint Pettit, MD, who chose medicine as a career in part because he enjoys talking with people.

When dealing with an illness of his own as an undergraduate engineering student at Tulane University in New Orleans, Dr. Pettit found that he enjoyed interacting with the physicians who helped him understand his course of treatment and recovery.

“I still wanted to do something in science,” he says, “but I liked the people aspect of medicine. So, I switched my major to biochemistry.”

After returning to his hometown of Omaha to earn a medical degree at the University of Nebraska Medical Center, Dr. Pettit began a residency in internal medicine at MedStar Georgetown University Hospital. There, he embraced the difficult task of helping patients and family members navigate through the medical system in a way that respected their wishes and helped them achieve their goals.

Palliative Care and Common Misconceptions

Dr. Pettit admits that palliative care is often perceived as a “depressing” field because all too many cases deal with end-of-life issues. But, he insists, that’s only one aspect of what is a multi-faceted, multi-disciplinary area of medicine.

“Palliative care emphasizes quality of life at any stage of serious illness and treatment,” Dr. Pettit explains. “We collaborate with the patients’ primary physicians and other specialists on treatment strategies, including managing pain and other symptoms, to help make the patient as comfortable as possible. We also provide counseling to help patients and loved ones cope with an illness’s emotional stress, and help them plan for post-hospital care.”

Dr. Pettit believes that with time and experience, palliative care will become better understood among both patients and other medical professionals. As research is one way to bridge the information gap, Dr. Pettit is studying how rapid response team nurses can better identify potential candidates for palliative care.

“We want to see if getting palliative care involved earlier in a hospitalization will have a positive effect on outcomes,” he says.

Dr. Pettit is also chairing the Clinical Competency Committee for MedStar Washington Hospital Center’s upcoming Hospice and Palliative Medicine fellowship program, which will help bring more newly minted physicians to the field.

Life Outside the Hospital

Because palliative medicine can be as emotionally draining as any other field of medicine, Dr. Pettit strives to maintain a balanced outlook through exercise, hiking and playing classical guitar. Yet even when confronted with a difficult case, Dr. Pettit and his team remain committed to finding a way forward.

“Difficult situations exist whether we like it or not,” Dr. Pettit says. “We try to face these situations head on, to make sure patients and their families always feel comfortable, supported, and respected, even when the medical outcome isn’t something we would have hoped for.”

Palliative Care: Improving Quality of Life for the Seriously Ill

From relieving pain to reducing symptoms to restoring peace of mind, palliative care helps seriously ill patients live a better life.

Caring for Body, Mind and Spirit

For hospitalized patients with cancer, heart failure or other chronic or progressive conditions, a relatively new medical sub-specialty offers an extra measure of healing, help and hope. Called palliative care, the interdisciplinary, holistic service provides ongoing relief from pain, symptoms and stress for patients of any age, at any stage of a serious illness.

The last point is particularly important.

“Many people think that palliative and hospice care are one and the same,” says Hunter Groninger, MD, director of the section of Palliative Care at MedStar Washington Hospital Center. “But there is a subtle yet crucial difference between the two. Palliative care is supportive, and available to anyone who needs it, for as long as they need it. Hospice care, while a type of palliative care, is restricted to patients at the end of life.”

With its broader mandate, palliative services are often administered along with treatments designed to cure or halt disease progression.

“Our team works hand-in-hand with the patient’s own doctors and specialists,” Dr. Groninger explains. “Palliative care is not an ‘either/or’ situation.  Rather, patients and their families get the best of both worlds: curative or disease-modifying care for their illness, supplemented by additional support for their physical, emotional, social and spiritual needs.”

The palliative care team is composed of specially trained physicians, social workers, a nurse practitioner, clinical pharmacist, spiritual counselor and specially trained volunteers. With the goal of reducing suffering and improving quality of life, the team works closely with patients and caregivers to define what’s important to them now and what they want to achieve in the context of their new reality.

“Serious illness, and physical pain in particular, can affect the emotions, relationships, routine activities and professional lives of both patients and family,” Dr. Groninger notes. “Our job is to  work with them together to make each day a little bit better.”

For the full podcast interview with Dr. Groninger, click here.

 

Have any questions?

For the full podcast interview with Dr. Groninger, click HERE

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What Does Heart Failure Mean for Intimacy?

What does Heart Failure Mean for Intimacy?

Patients with advanced illnesses face a variety of side effects. But little thought may be given to the concern of compromised physical intimacy.

That’s why our palliative care specialists decided to explore the matter further. Hunter Groninger, MD, director, Palliative Care, and Anne Kelemen, LICSW, Palliative Care social worker, designed a simple tool to assess sexuality and intimacy concerns among patients hospitalized with advanced conditions.

During the pilot study, 57 patients at MedStar Washington Hospital Center and MedStar Harbor Hospital were asked these questions during a palliative care consult:

  1. How much has your illness affected intimacy?
  1. How has your illness affected your relationships?
  1. Has this been discussed before during your hospital stay?
  1. Is this helpful to talk about?

Some 72 percent said that their condition had significantly or moderately impacted intimacy. For those facing the end of life, 83 percent reported the same feelings. Further, they wanted more conversation on the subject with their health care providers.

Defining Intimacy

Intimacy was defined broadly, including physical and emotional closeness, affectionate contact, sexual interactions and the communication of thoughts and feelings.

“Intimacy is bigger than just sexual intercourse. It can include cuddling, holding hands or playing with children or grandchildren,” Kelemen says.

Patients’ concerns included low libido, erectile dysfunction, lack of privacy and fear.  They also cited difficulties in finding and maintaining relationships overall.

“We had talked about the issues around intimacy, and knew they were overlooked,” Dr. Groninger says. “Then a family member brought up the issue, and we realized that it should be part of all routine palliative care consults. Patients do want to talk about intimacy, however they define it for themselves.”

Raising Awareness and Encouraging Open Conversations

Patients may not know how to bring up the subject. Kelemen describes such a case.

“I had a patient who had been hospitalized a very long time, and was nearing the end of his life. His wife wanted to talk to me; she wanted to have some ‘alone time’ with her husband, but didn’t know how to ask his doctors about that.”

Both researchers noted that important biases often exist.  First, clinicians often assume that intimacy only means physical sexuality or sexual health.  Second, clinicians often assume that patients with advanced conditions were too sick to be concerned with intimacy and sexuality.

“But we found that even patients at the end of life wanted to talk about these issues,” Dr. Groninger says.

George Ruiz, MD, MedStar Heart & Vascular Institute’s chief of Cardiology at MedStar Union Memorial Hospital and MedStar Good Samaritan Hospital, who was an advanced heart failure provider at the Hospital Center for 10 years, also believes that intimacy is important to these patients, and should be addressed.

“Heart failure systematically steals people’s humanity, taking away their ability to engage in living a full life,” Dr. Ruiz explains. “This includes walking around the house, climbing stairs and sharing intimacy. As physicians, we are so focused on the day-to-day challenges of caring for very sick patients, that we can overlook important quality-of-life issues these patients face.”

Kelemen stresses that addressing the issue is the whole point. “This is not just about addressing their concerns with VIAGRA®, it’s about having the conversation and encouraging conversations with their partners.”

It can be simple to do. “This is something any clinician can do,” Kelemen adds. “We just need to raise awareness and facilitate conversation.”

Samer Najjar, MD, medical director of Advanced Heart Failure for MedStar Heart & Vascular Institute at MedStar Washington Hospital Center, supports the effort. “We recognize that intimacy is important to patients at every stage of life,” he says.  “This is an important part of patients’ overall health.”

The end result? “We hope to educate providers about how to initiate this conversation,” Dr. Groninger says.

Have Questions?

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