it was clear that AIDS was not spread through casual contact but nonetheless there was great fear of occupational exposure among healthcare workers. As with Covid, there was widespread uncertainty and misinformation, though no internet to spread it widely. Perhaps because Covid is spread so readily from person to person in casual contexts, the resources marshalled against Covid dwarf those assigned to AIDS, especially early on. The speed of science and the development of an effective Covid vaccine seem miraculous and raise the question of how many lives we might have saved had we invested similarly in the early years of the fight against AIDS. And again, we have been called upon to provide palliative care in the face of a devastating and deadly disease. Fortunately, this time around we have well-established palliative care teams to respond and a more expansive understanding of palliative care. While our primary goal is still to help people achieve the best possible quality of life, the initial focus on end of life has grown to include people with life threatening illness at any stage of illness. Our palliative care team reached out to our outpatients to revisit their preferences for hospitalization and develop contingency plans to address symptoms at home. In the hospital we quickly deployed iPads to facilitate communication between families and patients and families and clinicians, a technology not available in the late 1980s. We provided education on discussing prognosis and goals of care and established a program of outreach to patients with Covid in the intensive care unit. When our colleagues in New York were overwhelmed by the pandemic, we were reminded that demand for palliative care far outstrips supply even in the best of times and volunteered to talk with their patients and families about prognosis and decision making.
In my 35 years in medicine in San Francisco I have practiced during two devastating pandemics. I have seen how science can tackle these scourges and offer effective treatments. I have witnessed how technology can mitigate the challenges and spread misinformation and bias that can exacerbate the situation, keep people from getting care, and lead to more death. I have also seen that caring and compassion, thoughtful communication, and hope are universal attributes of good care and that these lessons learned in the cauldron of one pandemic translated to the next. As we say in palliative care, I hope to never have to confront another pandemic, though I worry that I will. One thing I am sure of, with compassion and caring alongside scientific discovery we will meet any challenge with hope.” Steven Pantilat, MD is the Kates-Burnard and Hellman Distinguished Professor in Palliative Care and the Chief of the Division of Palliative Medicine at UCSF Health. Dr. Pantilat is an internationally recognized expert in Palliative Care. He has published over 130 peer-reviewed scientific papers and authored two dozen book chapters. Dr. Pantilat is the Board President of the Palliative Care Quality Collaborative, Chair of the Advisory Board for the Cambia Health Foundation’s Sojourns Scholar Leadership Program, and co-Director of the UCSF Palliative Care Leadership Center. He is the author of “Life After the Diagnosis: Expert Advice on Living Well with Serious Illness for Patients and their Caregivers” published by DaCapo Lifelong Books in 2017. Dr. Pantilat gave a TEDMED talk in 2018 and he and the palliative care team at UCSF are featured in the Academy Award-nominated, Netflix documentary, “End Game.”
PEARLS FROM THE PRACTICE A New Book from John Chuck, MD a focal Family Practitioner on how to thrive as a physician. This author was the recent guest at an SFMMS wellness book session, a recording of which is posted here: http://www.sfmms.org/get-help/physician-wellness.aspx
In recognition of a human condition that spans the entire spectrum from wonderful to miserable, and with a strong preference for the wonderful, Dr. John Chuck has drawn on over 30 years of experience as a clinician, wellness leader, and teacher to create Pearls from the Practice of Life – a family physician’s guide to help you struggle less and thrive more. His "pearls" of insight and wisdom will help you to better understand our shared predicament as human beings, namely our suffering and mortality, and leverage evidence-based habits to meet our hierarchy of needs for survival, safety, love and belonging, esteem, and self-actualization. Just as mollusks form pearls in response to irritants, Dr. Chuck believes that we can emerge from our struggles as newer, better versions of ourselves. In the pages of Pearls, find the makings of that metamorphosis. The book features 69 chapters divided into six parts. Read start to finish, it delivers a comprehensive message of hope and healing that begins with birth and ends with death. At the same time, each chapter is written so that it can stand alone as an inspirational message to be revisited or shared with others in need of perspective and encouragement. “Only Dr. John Chuck, a healer, an inspirational leader, and expert in wellness, could issue this prescription to thrive more. With a dose of humor and self-deprecation, Pearls builds on John’s wisdom from an incredible career and provides practical tips to help us flourish.” – Richard S. Isaacs, MD, FACS, CEO and Executive Director, The Permanente Medical Group, Inc.; President and CEO, The MidAtlantic Permanente Medical Group; P.C., Kaiser Permanente WWW.SFMMS.ORG
OCTOBER/NOVEMBER/DECEMBER 2021 SAN FRANCISCO MARIN MEDICINE
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