An Interview with the Hospice and Palliative Care Team

Recently we had the opportunity and pleasure of sitting down with Dr. Keith Mansel, Dr. Dan Woodliff, and Carole Ward, BSN, RN, also known as the Hospice and Palliative Care team.

Tell us about the Palliative Care Service.

Dr. Mansel: My background is pulmonary/critical care and I was on faculty here at one time.  Over the years, I have suffered with back trouble having three spinal fusions and did not work for a while.  This was an eye-opening experience to be both a patient and to experience pain. I wanted to go back to work but did not need to be standing on my feet all day in the ICU. Having had the experience of a patient and having guided many conversations with patients in the ICU, I went back at the age of 58 and did a palliative care fellowship at Mayo where I trained before.  I stayed on staff for 4 years and thought I would retire there.  But, Mississippi is home and they were looking to establish a program here.  I was not sure I wanted to start something new but this work gives me lots of energy and I am very passionate about it.  Dr. O’Mara and I talked back and forth and worked it out for me to come.  We have a great team.  It was a godsend to get Carole and then have Dr. Woodliff to join.  Everyone has been very receptive.  Many people do not know what palliative care is about and just think of it as end of life or hospice.  Most consults are for goals of care and helping with family conferences.  We also see patients for symptom management.  We have our first fellow Zach Pippin now, Rola Abi Saleh will start in January, and Doug Gibson in July.  Our vision is to broaden hospital-based consults, focus on the patients that could benefit most from our help and begin an outpatient clinic. An interest I also have is beginning a home-based palliative care program with the goal of allowing patients to be at home and focus on what is important to them.  The opportunities are endless.  In this stage of life and career you really want to focus on something that is meaningful and gives you energy. I get up every day and say what a privilege it is to get to come to work and do what I do.

Dr. Woodliff: One thing that Keith and Carole have taught me is anyone who does internal medicine or primary care does palliative care.  We all do this same type of work.  What is different for me is learning how difficult this is when you don’t have a relationship with the patient already.  Specialty palliative care is focused on extremely complicated, difficult patients.  They do not have one simple problem.  In a primary care setting, you take care of people over many years and have a relationship.  The hard part of this is walking in and not knowing the patient or the family and you are trying to build trust in a very short time period.  The complexity of the patient and not having the relationship is extremely demanding.  My hope is to share that with the students, house staff, fellows, and faculty so that they can learn how to do this also.  So much of this is the art of communication and Keith and Carole are masters at it.

Carole Ward: We are truly a team.  Both of these physicians have had a career in other fields of medicine, even though they did some primary palliative care.  They are now able to really focus on what is important to patients. That is why I am here also.  After having been in home health for a number of years watching patients go back numerous times to the emergency department for symptom management without any real understanding of their serious illness and the path ahead, I saw a need for them to have the kind of communication and care that our team provides.  This is a huge opportunity to help patients focus on what is important to them.

Dr. Mansel, you recently completed a four-year program called Faculty in Training. Tell us more about that.

Dr. Mansel: When I was at Mayo, I was fortunate enough to be part of the Effective Communication Healthcare faculty and we taught communication skills to our colleagues.  This introduced me to the Academy of Communication in Healthcare (ACH) and the FIT program.

I’d like to primarily use this training to help others practice what Dan Woodliff has done throughout his career. He is a physician of great experience and wisdom and he has practiced what we would call “primary palliative care”.  What we want to do is teach our colleagues to do primary palliative care – basic goals of care discussions, advanced care planning, and symptom management.  There will never be enough palliative care folks to do all of this.  We are there for the complicated, complex ones and want to teach our colleagues about effective communication.

The ACH focuses on basic communication skills and workshops that help you learn about group dynamics, group facilitation, and care conferences, how we run meetings, looking at what is going in the room with patients’ families and our colleagues.  Through this, they really focus on emotional intelligence – how do we learn and improve on our own personal awareness, read and respond to others emotions, manage our own emotions, and how we get along with others.  Now that I have completed the training, I can attend courses and use their materials at my own institution.

Through the FIT program, I have learned a lot about myself and have grown personally in this journey. This process has helped bring back the meaning and joy of medicine for me.  One of my big picture goals is I would love to think we are working towards home based palliative care, population health management, and then think of a communication skills offering for all our colleagues so that people could have time to learn about some of these relationships and skills practice.  It is about bringing back, I think, what we all really went into medicine for; compassion, caring for other folks, respect, kindness, humility.  It is not only about how we treat our patients and their families, but also how we in healthcare interact with each other.  We all want to do that and there are many demands in medicine and tasks that take us away from the relationships.  So how can we be sure we focus on this?  What I have learned is when you have the relationships right, then you are really better at getting the task done.  It is inevitable there will be conflict, but how do we engage and get to yes together? If you are wise, you learn from everyone you encounter.  Carole is our nurse navigator and I learn from her every day. We all learn from each other. You can learn from the custodian in the hallway if you take the time to listen.

On Friday, September 14, you all were guests on the WMPR 90.1 radio show.  How did this come about?

Carol: A month and a half ago we visited a patient and her son looked at Dr. Mansel and connected that we had been with him about a year ago with his dad.  His dad had died and he shared some of his feelings about that on the show.  The last time we met with him was about his mom, and he asked if we would be willing to come on the radio show. He so appreciated the time spent with his parents and he has a live radio show that has a wellness hour. He wanted to introduce palliative care to his audience, which is predominantly African American.  This is a topic that his audience does not like to discuss so he was not sure if there would have any call-ins. He invited us to come back over the holidays.

We spoke with Michael Thompson, host of the “Health and Prosperity Show” on WMPR and here is what he had to say.  

Michael Thompson: “They were awesome!  They did an excellent job and I have received so much positive feedback.  So many people called afterwards and even when I got home.  Some people do not like to talk on the radio but had questions. My mom passed away yesterday; I knew what to expect and went through this about a year ago with my father. Our community just does not like talking about this but we need to. I want to have them come back during the holidays.”

What is your favorite or most meaningful quote?

Dr. Mansel: There is a line in “Choruses from ‘The Rock’” by TS Eliot that reads, “where is the wisdom that we lost in the knowledge”.  I hope what we do is try to take all this information, take all this knowledge, and help patients/ families make wise decisions so that they receive care that is concordant with their goals.

Dr. Woodliff: The Serenity Prayer is what comes to mind for me.  “God grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference.”  There is a lot of this in what we all try to do every day and what these special and vulnerable patients are up against.

Carole Ward: Ellen Goodman, a Boston journalist and the catalyst behind The Conversation Project, has said, “The emphasis should be on talking about values, what matters to you, not what’s the matter with you.”  This is what these doctors are doing in helping patients and families make wise decisions.