Movements come and movements go.  To be memorable, to last, depends on continuously refining the message.  The brand, by necessity blindingly clear in the beginning, must be anything but static.  Ideas mature, knowledge grows, and movements pivot.  They must pivot.

The meteoric rise of hospice and palliative care has had untoward affects.  Specifically, the treatment of pain and suffering has dislodged itself from the moors of clinical medicine.  A new generation of caregivers rightfully have focused on symptomatology, but have unwittingly separated the body from the soul.  To deny that they are intertwined, is to practice a brand of medicine that lacks nuance.

When one treats edema from low albumin with diuretics, dehydration ensues,  When one treats psychic pain with narcotics, patients become more sleepy but no less mired in pain.  When one treats dementia induced agitation with benzodiazepines, more agitation is likely.

Good hospice care is grounded in classic internal medicine.  If we are not asking why are patients feel what they feel, we will ultimately fail at palliating them.  If we want to remain relevant.  If we want this movement to have teeth, we must redefine our place in the medical stratosphere.

Here’s how I see things.

Hospice and palliative care physicians should strive to be master diagnosticians.  We must be the detectives that parse not only the  physical but also the metaphysical.  We can no longer define pain and suffering as diagnoses.

Until we understand the how and why, our solutions will be misplaced and cockeyed.

It’s time to pivot.

Jordan Grumet is an internal medicine physician and founder, CrisisMD.  He blogs at In My Humble Opinion.