Torrance Based Physician Takes Whole Person Care to New Heights

August 31, 2016
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From The Torrence Tribune - Vol. 6, No. 37
By Brian Simon

While serving his internship in Fresno in the late 1970s, young physician in training Ira Byock had an interaction with a patient that would forever change his life. The exchange seems rather nondescript at first glance. “How are you doing this morning, Mr. Rodriguez?” Dr. Byock had asked. “I’m well,” Mr. Rodriguez replied. That was it. And yet, the patient was dying and knew very well that his days left on this planet were severely numbered. The moment left Dr. Byock perplexed.

“At first, I didn’t know what to do with it,” he said. “Was Mr. Rodriguez just being polite, or was he in some euphoric state from painkillers? But then I realized that it is possible to express a sense of well-being even if you know you are dying, may be sad about it, or are physically uncomfortable. The concept fascinated me and I knew then and there that I wanted to help other people achieve that feeling.”

Fast forward 37 years or so and Dr. Byock is now one of the nation’s foremost figures in the world of palliative medicine (specialized, multi-dimensional care for those with serious illnesses, with the focus on improving quality of life for both patient and family). He is the author of three acclaimed books (Dying Well, The Four Things That Matter Most, and The Best Care Possible) with countless essays under his belt as well as a 10-year directorial stint at the Dartmouth-Hitchcock Medical Center in New Hampshire that paved the way for his 2014 move to the South Bay to head up the Providence Institute for Human Caring at the Torrance-based Providence Health & Services. The Institute’s mission (as noted on the website is to “help people understand how they can be more engaged in their own care, how to support loved ones who are experiencing medical issues and how best to cope with the strains of caregiving, and later, the strains of grief.” The Institute’s staff of 16 includes physicians, nurses, educators and data analysts who work closely with doctors, hospital leaders and other health care professionals encompassing a 50-hospital, seven-state system to give them the tools to provide the best possible whole person care.

As Dr. Byock explained, “Individuals are not just defined by their diagnoses and need for treatment, but as people with emotional, interpersonal, social and spiritual components. We want to attend to their needs and maximize their comfort and well-being including during difficult times of illness. There is clear agreement that American mainstream medicine often does more to people who are dying than is in anyone’s best interest. We are finding that by focusing on people’s well-being and not just their disease that they tend to live longer and feel better—and costs are down because they get their needs met more often at home.”

To further elaborate the difference between the old and new models of care, Dr. Byock presented two different versions of a particular patient case study: “Let’s say someone has surgery on his heart valve, but has a stroke during the surgery. The family is shocked. The patient is on a ventilator, can’t speak, is sedated and on powerful drugs. It’s common for the family members to not know what to do and they are unable to speak with any authority about the patient’s wishes. By default, the patient stays in ICU. If they don’t get better, they transfer to long-term acute care or die in ICU. In contrast—under highly personalized care, the risks are well-discussed before surgery with the patient and family members on what they would want to have happen if there is a stroke or other complication. The family would have clear authority to speak on the patient’s behalf. Every five to seven days in ICU, there would be a formal conversation to see if the treatment is consistent with what was wanted. And the family will also be ‘treated’ for their own stress to ensure they are getting enough rest, have a place to clean up or shower and ways to communicate with extended family and friends. We would look at this as a personal experience and not just a medical event.”

Among the most telling statistics, 70 percent of Americans say they would rather die at home surrounded by loved ones than in a hospital—and yet sure enough, 70 percent die in a hospital, nursing home or long-term care facility. The result in most cases is unnecessary, ineffective, often-unwanted and very costly medical treatments at the end of life that can lead to financial ruin and family discord. To address the situation, Dr. Byock advocates that all patients over 18 have advance health care directives on file. Under the new system, caregivers receive training on how to provide advanced care planning and how to discuss serious illnesses with patients and families while always keeping the patient’s specific needs at the forefront.

“If we know anything about illness, people’s needs are highly personal—so the best care is not a one-size-fits-all model,” Dr. Byock noted. “Before we ask, ‘What’s the matter with you?’…we ask, ‘What matters most to you?’ so that we can make sure we’re not just doing things to people but know what their goals are in order to make decisions about treatment with them and not for them. Ethnicity, upbringing, religion and individual idiosyncrasies can all play a part.”

While it has taken decades to get this far, Dr. Byock reports huge inroads made in moving to a whole person care philosophy. “Through the work the Institute is doing, we are driving a transformation that can be an example to the rest of the country,” he said. “The future of health care is in person-centered care and Providence Little Company of Mary is an ardent supporter and major leader in this progression.”

Born and raised on the Jersey Shore, Dr. Byock had no clue what he wanted to do for his future living when he started his college studies in the Washington, D.C. area. “In high school, my assumption was whatever I did in my career shouldn’t require that much college,” he said. He took a few political science courses, but found himself floundering.

“But then when I challenged that assumption and just looked at what truly interested me, it was clear I wanted to help take care of people. It was like the clouds finally cleared.” He went on to complete his undergrad work at the University of Colorado with a degree in biology and continued to medical school there with the eventual post-graduate work in Fresno as part of the University of California, San Francisco program.

“I thought I would be a rural family doctor and did that for a short time,” Dr. Byock said of his early career. “I was also enamored with emergency medicine and started a hospice. I did a lot of volunteer work and saw many patients at their homes.” Spurred by his experience with Mr. Rodriguez and others, he began to serve on committees as an early proponent of palliative care and wrote a number of papers on the subject. In the late 1990s, he accepted an offer to lead a national program to provide grants and technical assistance to health care systems trying to integrate hospice-like care within the mainstream.

Dr. Byock worked with the Robert Wood Johnson Foundation to establish palliative care in ICUs, rural health clinics, pediatric specialty hospitals and even the state penitentiary. “It all worked brilliantly and opened up the doors to expand palliative care across the country,” he said. “At Dartmouth, we spent a decade building out palliative care within the medical center and through teaching programs. Now at Providence, we hope to take it to the next level where the whole person model will be the new mainstream.”

Married with two grown daughters and a couple of grandkids plus other family in the Los Angeles area, Dr. Byock lives close to the hospital and has quickly grown used to the pleasures of West Coast weather and the South Bay’s many amenities. “We are enjoying ourselves a great deal,” he confirmed, though he admitted his schedule is packed to the gills. “I rarely get to see patients anymore these days. At this point, I need to do what I can do to support others in this effort…”