End of Life Care

August Physician Focus: Advance Care Planning

Posted in End of Life Care, Palliative Care, Physician Focus, Uncategorized on July 31st, 2014 by MMS Communications – Comments Off

Physicians are increasingly recognizing the importance of advance care planning – preparation for the end-of-life -  and as the subject gains more public attention, more patients are being motivated to talk about the issues.

The August edition of Physician Focus shares the physician’s perspective on this topic with two members of the Massachusetts Medical Society’s Committee on Geriatric Medicine.

Eric Reines, M.D., (photo, center) a geriatrician with Element Care in Lynn and chair of the committee, and Beth Warner, D.O., (right) a consultant geriatrician with Cooley Dickinson Health Care in Northampton and committee member, join host and primary care physician Bruce Karlin, M.D. (left) to discuss the basics of advance care planning.

Among the topics of conversation are the importance and advantages of planning, when it should begin, how to start the process, and the physician’s role in the process. Healthcare proxies, medical orders for life-sustaining treatment, and hospice and palliative care are also included in the discussion.

Physician Focus is available for viewing on public access television stations throughout Massachusetts. It is also available online at www.massmed.org/physicianfocus, www.physicianfocus.org,  and on YouTube.

Lahey Clinic Medical Ethics Lecture Series: The Arguments Against Question 2

Posted in End of Life Care, Physician Assisted Suicide on September 20th, 2012 by MMS – Comments Off

Richard V. Aghababian, MDThis week, MMS President Richard V. Aghababian, MD, spoke at the Lahey Clinic in Burlington, presenting the MMS position against the physician-assisted suicide referendum on the Massachusetts ballot.

Dr. Aghababian said, “Physician participation in assisted suicide is fundamentally at odds with our duty to be healers.”

He added, ”Our medical society first voted against physician-assisted suicide in 1999. It was reaffirmed in a vote nearly a year ago. At the same time, we reiterated our commitment to provide physicians who treat terminally ill patients with ethical, medical, social and legal education and resources.”

Five Ways You Can Meet the State’s New CME Licensing Requirements

Posted in Board of Medicine, CME, End of Life Care on January 20th, 2012 by Erica Noonan – Comments Off

The state Board of Registration in Medicine notified physicians this week of new regulations that require them to complete CME courses in pain management and end of life care during the license renewal or obtaining a new license.

Pain management: Effective Feb. 1, physicians who prescribe controlled substances (Schedules I through VI) must complete at least three credits of education and training in pain management and opioid education.

MMS and the Boston University School of Medicine offer two courses to help physicians fulfill that requirement:

End-of-life care: Also effective Feb. 1, all physicians seeking a new or renewed license must take two CME credits in end of life care. The credits can qualify as either category 1 or category 2, and may be counted as risk management credits.

The MMS offers three online courses to fulfill this requirement:

The pain management education requirement was created by the Legislature in statute enacted in 2010. In public testimony, the MMS unsuccessfully opposed that requirement.

Mandatory education in end-of-life care was imposed by the Board of Registration in Medicine (BRM) following the recommendation of a special commission. It was not a legislative mandate, and the MMS opposed the inclusion of this condition for licensure based solely on the BRM’s perception of the significance of the issue.

BRM Executive Director Stancel Riley, MD, is scheduled to meet the MMS Board of Trustees in March to discuss these and other new licensing regulations.

 

 

Board of Medicine Moves to Require CME Credits in Pain Management and End of Life Care

Posted in CME, End of Life Care, Palliative Care on January 12th, 2012 by MMS – 5 Comments

We learned today that the Massachusetts Board of Registration in Medicine is notifying physicians by email that effective Feb. 1, it will require continuing medical education (CME) credits on two specific clinical topics as a condition of licensure and re-licensure: pain management and end of life care.

It will require three hours of CME credits in pain management for physicians who prescribe controlled substances (Schedules I through VI). These credits qualify as either category 1 or category 2 CME, and may be counted as risk management credits. This requirement was established by the Legislature by statute in 2010.

The MMS recommends two courses to fulfill this requirement:

The Board will also require physicians to take two credits in education about end-of-life care, also effective Feb. 1.  The credits qualify as either category 1 or category 2, and may be counted as risk management credits. This is a requirement imposed by the Board very recently, following the recommendations of an expert panel on end of life care that met in 2008.

The MMS online CME center offers three courses that would fulfill this requirement:

The state’s complete CME requirements for licensure and re-licensure are available on the MMS website.

MOLST Expands End-of-Life Planning for Physicians, Patients

Posted in CME, End of Life Care, Palliative Care on November 3rd, 2011 by Erica Noonan – Comments Off

Too often, palliative care experts say, physicians are unable to carry out their patients end-of life wishes because they were contained in a document that was incomplete, too vague, not legally binding, or simply misplaced by family members.

Massachusetts is poised to join more than 14 other states with formal Physician Orders for Life-Sustaining Treatment (POLST) programs. The proposed state protocol, called Massachusetts Medical Orders for Life Sustaining Treatment (MOLST), aims to translate patients’ goals of care into specific medical orders that travel with the patient if he/she changes health care settings.

MOLST differs from the most common type of palliative care planning – advanced directive orders, which usually include a “living will” or other expression of wishes. Those orders generally designate a surrogate decision maker, or health care proxy, to act on behalf of an incapacitated patient.

Living will instructions – when presented by a health care proxy – are generally recognized as evidence of patient preferences, but are not recognized by Massachusetts law.

In contrast, a completed MOLST form travels with the patient at all times, may be faxed or reproduced, and is an official part of a patient’s medical record.  MOLST is more comprehensive than another common end-of-life preference form, the Massachusetts Comfort Care/DNR Verification Protocol, which covers emergency hospital transport and resuscitation efforts.

The MOLST document, which is signed by both patient and physician, encompasses these procedures, as well as breathing tubes and ventilation, artificial nutrition and hydration and dialysis.   Patients or their health care proxy can change MOLST preferences at any time.

A successful MOLST pilot program in the Worcester area was completed earlier this year and the Executive Office of Health and Human Services is currently evaluating feedback from medical professionals there to shape policy. The Massachusetts Expert Panel on End-of-Life Care has recommended statewide implementation of MOLST by early 2014.

To learn more about presenting the MOLST option with patients, and how to use MOLST to facilitate conversations about end-of-life care, join us on Dec. 6 for a webinar featuring Dr. Susan Block, co-director of the Harvard Medical School Center for Palliative Care. Visit www.massmed.org/molst for more information.

-  Erica Noonan

MOLST: A New Approach for End-of-Life Care

Posted in CME, End of Life Care, Palliative Care on October 18th, 2011 by Erica Noonan – Comments Off

An estimated 75 percent of patients will be unable to make some of their own medical decisions at the end of their lives. More physicians and clinicians are now finding that advanced directives and living wills are often too vague or unenforceable to ensure optimal care for dying patients.

To ensure patients receive the end-of-life care they desire, Massachusetts is poised to join more than 14 other states with formal Physician Orders for Life-Sustaining Treatment (POLST) programs.

The proposed state protocol, called Massachusetts Medical Orders for Life Sustaining Treatment (MOLST), aims to translate patients’ goals of care into specific medical orders that travel with the patient if he/she changes health care settings.

The MOLST document, signed by both patient and physician, covers specific health care therapies such as CPR, breathing tubes and ventilation, artificial nutrition and hydration, as well as more general patient preferences about issues such as hospital transport. A patient or health care proxy can change MOLST preferences at any time.

Unlike an advanced directive, which often designates a surrogate decision maker and is not part of a patient’s file, a MOLST form travels with the patient at all times and is an official part of a patient’s medical record.

State palliative care experts say they expect MOLST to soon become part of standard patient care for many Massachusetts clinicians. A successful MOLST pilot program in the Worcester area was completed earlier this year and the Executive Office of Health and Human Services is currently evaluating feedback from medical professionals there to shape policy.  The Massachusetts Expert Panel on End-of-Life Care has recommended statewide implementation of MOLST by early 2014.

To learn more about presenting the MOLST option with patients, and how to use MOLST to facilitate conversations about end-of-life care, join us on Dec. 6 for a webinar featuring Dr. Susan Block, co-director of the Harvard Medical School Center for Palliative Care. Visit www.massmed.org/molst for more information.

-          Erica Noonan