By THERESA HOGUE
Gazette-Times reporter | Posted: Saturday, August 23, 2008 12:00 am
Doctor practices end-of-life care
Dr. Shawn Foley has long believed that it was his obligation to give his patients both a sound medical diagnosis - and hope.
Foley, who works with everyone from infants to the elderly as a family practitioner with Philomath Family Medicine, has learned a lot in his new role as medical director of Benton Hospice. Now, he continues to be a sympathetic counselor to his patients. But he's also become more prepared to discuss options with them when aggressive treatments might not be the right course.
"I've learned how to talk about changing goals, and looking at life-prolonging therapy versus symptom management," he said.
Foley has been on the board of Benton Hospice for more than five years. He recently took over as medical director from Dr. Pam Turner, who retired from the position in July. As medical director, Foley oversees care plans for hospice patients, and evaluates requests to participate in the hospice program.
He is assisted by Dr. Sharon Lissman, who is assistant medical director with hospice. Lissman is a hospitalist with Good Samaritan Regional Medical Center and is working on developing a palliative care program, which is focused on reducing symptoms rather than pursuing cures that have no realistic chance of saving the patient.
In other words, hospice patients are facing death, and hospice workers are focused on keeping them as comfortable as possible in their last days. Typically, the patients who are enrolled in hospice have a life expectancy of six months or less.
Estimating end-of-life expectancy is difficult, Foley said. Although the duration and stages of diseases such as cancer can be predicted more accurately, other terminal illnesses are less predictable. Age-related conditions such dementia and even health factors as vague as "failure to thrive" indicate that a person's life might be nearing the end - but how much time remains isn't something that medicine always can predict.
"Our bodies just wear out. Sometimes it's not even one specific thing," Foley said. "Several systems (might not) work."
Hospice enables physicians to make judgment calls on when patients are ready for Hospice. When deciding when that time is at hand, Foley said, he sometimes asks, "Would I be surprised if this person wasn't alive in six months?"
Hospice also enables Foley to continue a practice that has disappeared from many modern health care environments: house calls.
Growing up in South Dakota, Foley watched his father, who also was a doctor, make house calls around town. Now, when he gets the chance, he does the same thing with Philomath Family Medicine. It makes a difference, he said.
"When you see them in clinic, you have 15 minutes with them, and you have to make difficult decisions and judgments," Foley said. "When you see them at home, you get a totally different picture. I wish we had more time as physicians to do that."
Working with Benton Hospice patients, Foley said, he often finds himself re-evaluating what's important in his own life, and recognizing the finite quality of his relationships. He said the staff members of hospice continue to surprise him with their empathy and dedication.
"It takes a special person to handle that, to go through losses all the time …" Foley said. "(In hospice) I find some of the best people I've ever met in my life."
For more information on Benton Hospice, see www.