Chapter 10: Building the Reputation of Palliative Care

Chapter 10: Building the Reputation of Palliative Care



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In this chapter, Dr. Fisch sketches how the talented team in palliative care was successful in securing regular referrals from a few oncologists, building the program’s reputation. He tells anecdotes about the surprising and positive results they would get from integrating palliative approaches into treatment protocols.

At the end of this chapter, Dr. Fisch shares lessons he learned about how to interact successfully with oncologists to ensure they would call on him as a palliative care providers.



Publication Date



Houston, Texas

Topics Covered

An Institutional Unit; Patients; Patients, Treatment, Survivors; Discovery and Success; Building/Transforming the Institution; Multi-disciplinary Approaches; Professional Practice; The Professional at Work


Michael Fisch, MD:

So it got repaired and we had a talented group. I mean, these people knew what they were doing. Eduardo and his team know how to take care of patients. He had great ideas, we were doing good things, and gradually that sort of got noticed. Really, there was just a very small number of faculty who would refer to us. I mean, we seeded the whole thing, more or less, it seemed like, on the power of referrals from like maybe three or four people in the whole place, but they could hand us enough patients to keep us afloat, and then our work could seed and spread a little bit. But Cathy Pisters was one of the main ones, Katherine Pisters in Thoracic, got to know her and come to be such an admirer of her and her friend. But if it weren’t for Kathy Pisters, and Bob Wolff was another, and just a few other people who let us in and let us do our thing. Then the other thing I remember is sometimes we’d do things—you know, because I was learning the field, but we would switch medicines around, rotate the opioids, and address constipation and address psychosocial distress and spiritual well-being, and sort of deliver a package of palliative care that was pretty cool, and sometimes people would go from literally being what seemed like in a complete heap, just—you know, I remember one patient with an eye patch, nauseated, constipated, couldn’t walk, everything was miserable, and he has a young family, and then we kind of do what we do, and literally within a week, he’s way better. He can walk, he can eat, he can think, and then their family got ready. They were so uplifted, and then they went on this great beach trip, and it was just fantastic. But I remember it’s sort of like spiking the ball after a touchdown. You just get so excited. But sometimes we would succeed so dramatically that it was a little bit off-putting to a referring doctor. Imagine if you’re in that kind of heap, and then you see somebody and they fix it, you’re like super thrilled, but you’re also thinking, “How did I get like this and how long was I like this until I met you?” And you feel a little bit bad about these people who didn’t know how to solve this problem or didn’t know how to refer sooner. So there’s sort of a good news/bad news effect. The good news is it feels good for us, like we’re the heroes. Feels bad for the referring doctor. Rule number one, don’t succeed in a way that’s painful for the referring doctors if you like referrals. So we learned how to—and maybe they already knew this, but I learned at least how to be a very quiet, humble solver and how to have these, in a sense, sort of like score a touchdown and just hand the ball to the referee. Don’t have a big celebration. That celebration does not do you any good. Let you be understated in solving these problems. And also sometimes I would get used to solving these problems and it would seem too easy. I could see it. It’s like seeing you’re going to score, and I’d say, “We can fix this. You watch what we can do. We’re going to do this.” Then, you know, medicine humbles you and life humbles you, and some of the solutions couldn’t be always reproduced because their life is complicated. So learn to be much more measured about what I thought we could always achieve and quiet about it when we did achieve it. That’s sort of in the comeuppance of—again, maybe that’s Consult 101, you know, whether you’re putting in stents in a biliary tract or doing palliative care. Wow people quietly, not loudly. But that was all part of the experience.

Tacey Ann Rosolowski, PhD:

Well, we’re at noon. Shall we leave it here for today?

Michael Fisch, MD:

Yes, yes. I didn’t realize we were already at noon. I’ve got to show up to another meeting real quick.

Tacey Ann Rosolowski, PhD:

Well, I look forward to talking to you next week.

Michael Fisch, MD:

Thanks so much for your time, and I look forward to talking to you some more. I’ll run off to my meeting.

Tacey Ann Rosolowski, PhD:

All right. I’m turning off the recorder at noon.

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Chapter 10: Building the Reputation of Palliative Care