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Innovative Solutions for the Business of Health Care Akron n Cleveland n Lorain County n www.brouse.com The challenges faced by health care providers may also be opportunities for growth and prosperity. This requires a comprehensive knowledge of the law, and a clear understanding of health care as a business. Brouse understands the operations, market trends and economics of the health care industry. It's more than legal advice, it's a business solution. For more information, please contact: Daniel Glessner, Esq., Practice Chair 330.535.5711 x316 | dglessner@brouse.com Christopher Huryn, Esq., Partner 330.535.5711 x389 | churyn@brouse.com David Schweighoefer, Esq., Partner 216.830.6830 x277 | dschweighoefer@brouse.com J. Ryan Williams, Esq., Partner 216.830.6830 x592 | rwilliams@brouse.com TODAY'S HOSPICE AND palliative care physicians owe a debt of grati- tude to Dame Cicely Saunders, who founded St. Christopher's Hospice in 1967. As a nurse, turned social worker, turned physician, she articulated a radically new approach to conceptualizing pain. It transformed the way society cares for the ill, the dying and the bereaved. The cornerstone of her philosophy is the total pain model. Saunders defined total pain as suering that encompasses physical, psychological, social, spiritual and practical struggles. The diagnosis of a life-threatening illness frequently brings these complexities to the forefront. Pain and suering are related, but not necessarily the same. Pain, whether physical or emotional, has a physiologic basis. Suering, on the other hand, arises when individuals apply meaning or "tell themselves stories" about the pain they are experiencing. A patient with severe cancer-related pain, for instance, may have intractable suering if he or she believes the cancer is "punishment" for prior misdeeds. It is crucial that physicians recognize, validate and address the interrelated contributing components. Pain can often be alleviated or improved with medication, whereas suering often is resistant to medication. Failing to recognize the dierence can lead to over-medication and over-sedation of patients who have serious and life-limiting illness. Families often resist the recommendation for a hospice refer - ral due to concerns about over-sedation and over-medication. Understanding the hospice team's role in addressing total pain can enable referring physicians to alleviate concerns. The hospice transdisciplinary team is comprised of skilled professiona ls from many disciplines working as a cohesive unit. This allows the patient and family to receive focused care that addresses the complexity of termina l illness. The ma nagement of suering, especia lly spiritua l pa in, requires time, and is best delivered by hospice involvement early in the course of a termina l illness. Referra ls that a llow su‹cient time for hospice to do this work are fundamenta l to ma ximizing qua lity of life and achieving peace. Dr. Kevin Dieter is Medical Director of Hospice of the Western Reserve. He oversees care and conducts teaching rounds at the nonprofit agency's David Simpson Hospice House IPU, and also supervises a Cleveland east side home care clinical team. ■ S P E C I A L S E C T I O N : H O S P I C E ❰❰❰❰❰ 1 7 HOSPICE ADDRESSES BY KEVIN DIETER, MD, FA AHPM Complexities of Suœering M D N E W S . C O M /// M D N E W S C L E V E L A N D /A K R O N / C A N T O N ■ N O V E M B E R / D E C E M B E R 2 016