Dr. Sharon Baker is a family physician-trained palliative care consultant who leads the palliative team at UH. The UH Palliative Care rotation consists of being a member of the palliative care consult service together with the palliative care consultant and a nurse practitioner. Together the team provides both palliative and pain/symptom management consultations and follow up to any other service in the hospital. At UH there are many consults to general surgery, medicine, and neurology services in particular.
Teaching to Service ratioEdit
The team usually shares a list of anywhere between 8-20 palliative/pain patients. There is lots of case-based teaching throughout the day while caring for patients, meeting with families, case conferences, etc.
There is bi-weekly palliative care rounds jointly with the palliative physicians/nurses at Victoria hospital.
You have to do a short presentation during lunchtime palliative care rounds during your rotation, topic of your choice!
Had a different experience. We were never asked to do presentations. Each of us 2 FM residents had 9-10 patients per day for consults or inpatient. The NP would look after another 7-8 patients.
Usually only 1 family medicine resident on the team at UH.
We had 2 FM residents , both PGY1s.
LHSC-UH - general consults from any service in the hospital for palliative care AND/OR pain and symptom management. There is also a short-term palliative care unit (shared with the Family Medicine Unit, 6W)
Usually the consults are from Neurosurg or Neurology for either symptom management eg pain, dyspnea or for goals of care discussion or end of life issues. Some CTU patients were referred for goals of care discussions or disposition for longterm palliative care at Parkwood usually.
Patients from London and surrounding region.
Week in the Life of...Edit
What does a typical work week look like on this rotation? Edit
Daily "running of the list" and following/seeing your palliative patients. Usually 1-3 new consults a day, shared between resident and nurse practitioner. Occasional family or case conferences to discuss care especially around transition of goals of care to a palliative approach.
Day typically started at 0900. Since Dr Baker comes in after 0930, we would finish rounding our inpatients or patients with more immediate issues before running the list with her.There is no designated lunch break time. Everyone breaks up for lunch whenever free. Day ends at 4 to after 5 pm depending on caseload.
1 weekend of call, no new consults. Only required to round on Palliative Unit patients (not patients under other services), ie. usually only 2-8 patients to see on each of Saturday and Sunday mornings. Also responsible for death summaries/certificates while on-call.
With 2 FM residents, we had only 1 Saturday or Sunday on-call. There are weekday calls as well . it depends on what Dr Baker's schedule for calls is, that month. She was on-call the first week of our block but she chose not to put us on call. Her theory is not to leave her patients in the hands of new residents:) So she did the call herself the whole week.
Other Things to addEdit
Very good rotation for becoming comfortable with narcotics in palliative care and also in chronic pain.
Unlike VH palliative care which is typically oncology patuents for end of life orpalliative care, this rotation has variety of patients and very diverse symptom management issues.Lots and lots of goals of care discussions and family meetings to discuss that. Good rotation if you feel uncomfortable breaking bad news or discussing stopping aggressive treatment for end of life care.