Eduardo Bruera, MD, FAAHPM: A Brief History Of Palliative Care

Dr. Eduardo Bruera sits down with Selma Schimmel in The Group Room where he gives a brief overview of the history and origins of palliative care in this country.

This interview was filmed at the American Society of Clinical Oncology Annual Meeting in Chicago 2013.

Eduardo Bruera, MD, FAAHPM is the Department Chair, Palliative Care & Rehabilitation Medicine at the UT MD Anderson Cancer Center.

Advocacy and educational support provided at ASCO 2013, in part, by:

TGR ASCO 2013 Sponsor VIDEO TRANSCRIPT

Selma Schimmel, Founder & CEO, Vital Options International:

This is Selma Schimmel and you are looking live at the great city of Chicago which is once again playing host to the American Society of Clinical Oncology, ASCO.  This is ASCO’s 49th annual meeting and this year’s theme could not be more appropriate, Building Bridges to Conquer Cancer.  More than 30,000 of the world’s foremost cancer specialists are here and so is The Group Room making our 15th appearance at ASCO, and one of our very best.  Joining me now is Dr. Eduardo Bruera- department chair, the department of palliative care and rehabilitation medicine in the division of cancer medicine at the University of Texas, M.D. Anderson Cancer Center in Houston.  Hello, Dr. Bruera.

Eduardo Bruera, MD, FAAHPM, Dept. Chair, Palliative Care & Rehabilitation Med, UT MD Anderson Cancer Center:

Hi.

Selma Schimmel:

If you would, give me us some history, some background, into the evolution of palliative care.

Eduardo Bruera, MD, FAAHPM:

Palliative care started really as what is called the UK hospice movement in the 60’s and Cicely Saunders was kind of a revolutionary person and basically took care of patients who were not receiving very good care by organized medicine.  So, we are really a movement of the 60’s.  We should be seen as a fringe movement that does not start in the big universities.  It did not start in the organized hospitals; it started as kind of a revolutionary movement.  So, this fringe movement was progressively adopted and it crossed the ocean to Montreal where Dr. Bal Mount basically created the word ‘palliative care’.  When hospice care, that took place in basically self-standing houses, or at home, was for the first time practiced in teaching hospitals and Bal Mount created this word palliative care.

Selma Schimmel:

About what year was that?

Eduardo Bruera, MD, FAAHPM:

His first opening of a palliative care unit was in 1976 in Montreal, so quite a few years ago.  If you think about it, very mainstream specialties like emergency medicine or critical care medicine that were created by mainstream medicine were born later than palliative, but those were born within organized medicine and you couldn’t even imagine today an acute care hospital not having an emergency center or an ICU, but still today in American most acute care hospitals do not have a palliative care unit and a small number of American hospitals have an outpatient center for palliative care.  So, it’s taken longer for palliative care to be adopted because it was not born out of organized medicine and academic medicine, it was almost by popular demand that it became progressively adopted and has now become kind of more widely adopted.

Selma Schimmel:

Since palliative care specialists can come from many different disciplines, what is the education if one is already, let’s say a board certified doctor of internal medicine, what does he or she have to do to become a palliative care specialist?

Eduardo Bruera, MD, FAAHPM:

They have to take one year fellowship in an accredited institution, for example, Anderson has five slots every year to train for one year one of those specialists into this subspecialty and after that they have to take a board exam and they become subspecialists in palliative medicine

Selma Schimmel:

And in medical school education, is palliative care being integrated into the curriculum.

Eduardo Bruera, MD, FAAHPM:

At a very variable and generally slow speed.  For example, not only medical schools, in postgraduate education we have a one month mandatory fellowship training for medical oncologists at MD Anderson but none of our competitors have that at this point and it’s a big problem because when those medical oncologists spend one month with us they become the most rabid advocates of using palliative and supportive care.  So I would like to take this opportunity to invite the fellowship program directors to take advantage because this is scored by our medical oncology trainees as one of the highest rotations in their training experience.  So you’re going to make your medical oncology fellows happier and you’re really going to make a great service to the development of the specialty if you make these one month mandatory rotation present.  In fact, ASCO strongly recommends that this be done but you know, some of the biggest don’t even still have a one month mandatory rotation in palliative care.

Selma Schimmel:

I’m very grateful that you took time out to spend with us today in The Group Room.  Dr. Eduardo Bruera: department chair, the department of palliative care and rehabilitation medicine in the division of cancer medicine at the University of Texas, MD Anderson Cancer Center in Houston.   Thank you so very much.

Eduardo Bruera, MD, FAAHPM:

Thank you.  Thanks for having me here.

END OF VIDEO

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