Palliative care and hospitalists: A partnership for hope

It is right and fitting that an article focused on palliative care appears in the inaugural issue of the Journal of Hospital Medicine (JHM). Both hospital medicine and palliative care are rapidly growing fields expanding in response to quality and economic imperatives. Both fields recognize the need to develop systems to care for seriously ill patients and to work within interdisciplinary teams. In fact, a natural and mutually beneficial relationship should exist between these two fields. For palliative care, hospital medicine and hospitalists offer the physicians and systems approach to care that could guarantee access to high-quality palliative care for all hospitalized patients. In addition, hospitalists offer the promise of increasing the number of hospital-based palliative care programs as the presence of a hospitalist program is strongly associated with having or starting such a program. For hospital medicine and hospitalists, palliative care offers a compassionate and high-quality response to the challenge of caring for seriously and terminally ill patients and their families. By each embracing the other, both fields could find willing and eager partners in the quest to provide the highest possible quality of care for hospitalized patients. In this first issue of JHM, Dr. Meier offers hospitalists an intriguing and attractive picture of palliative care. She describes how the growth of palliative care is driven by the needs of an ever-larger group of patients living with chronic and life-threatening illness and evidence of high quality and satisfaction for these patients who have many physical, emotional, psychological, and spiritual concerns. Dr. Meier also demonstrates how hospitalbased palliative care can coordinate with hospices to provide the continuity of care for terminally ill patients that is often elusive at hospital discharge. Finally, Dr. Meier provides a practical list of resources for clinicians seeking further training in the field. No doubt hospitalists will appreciate this list as the core competencies in hospital medicine, published as a supplement to this issue of JHM, include palliative care, pain management, communication, and discharge planning. As Dr. Meier states in her article “Palliative Care in Hospitals,” many types of clinicians can provide palliative care in hospitals, including general internists, nurses, geriatricians, oncologists, hospitalists, and others, yet hospitalists are likely to emerge as the predominant providers of palliative care to hospitalized patients. That 75% of Americans die in institutionalized settings, where hospitalists are becoming the dominant providers of care, will drive this prediction. In addition, hospitalists are increasingly leading efforts in quality improvement, patient satisfaction, and patient safety. Of necessity these initiatives will involve the sickE D I T O R I A L