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A Busy ER Doctor Slows Down To Help Patients Cope With Pain

WebMD News from Kaiser Health News

By Annie Feidt, Alaska Public Radio

Wed, Jul 03 2013

Dr. Linda Smith walks into a room at Providence Alaska Medical Center, ready with a stethoscope and a huge grin. She teases her patient, Dawn Dillard, saying that her spiky hair recently resembled a "faux hawk."

Dillard found out she had uterine cancer a year ago. Her oncologist gave her a year to live. The 57-year-old has beaten those odds, but now her kidneys are failing. After the laughs are over, Smith sits down on the edge of Dillard's bed, leans in, and starts talking about a surgical procedure to help her kidneys.

Smith is a palliative care doctor, a specialty that is growing rapidly in the U.S. The idea is to help patients cope with a terminal or life-altering illness. And unlike hospice care, it is not offered only in the final months of life. Smith works on pain management, coordinating care and even does some counseling. Dillard, who is now in chemotherapy again, really appreciates it.

"I can't even say how much she's helped me," Dillard says. "Just little things. You know, showing me things like breathing techniques. Sort of like mediation, just ways to focus on things that are positive and happy rather than focusing on your sickness and how crappy you feel."

Becoming A Better Listener

Two years ago, Linda Smith was a very different kind of doctor.

She worked in the emergency room at the busy Anchorage hospital, where the goal was to quickly stabilize a patient and move on. But two decades into her career, she started to question how she was caring for patients at the very end of their lives. She remembers putting patients on breathing tubes and hearing family members say things like, "I know Dad didn't want this, but we're just not ready to let him go."

"I started to have a lot of regret about doing things to people that were painful and uncomfortable and were prolonging their suffering," Smith says. She thought, "if I only had the time to sit down with the family, I probably wouldn't be doing these things."

In 2011, Smith enrolled in a one-year palliative care fellowship at Providence. She had a lot to learn. She found out she was a bad listener. And she was abrupt. As an ER doctor, sometimes she was so busy she didn't even sit down to deliver devastating news.

"I can remember saying to families things like, 'I'm sorry, there's nothing more I can do.' And I realize now that sounds like abandonment to many people when you say you can't do anything more. And the reality is I may not be able to do anything more to the patient that will make them survive, but there's a lot more that I can do. I always can do more."

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