Dr. Pierre Lavedan, Medical Director of Palliative Care
Dr. Michael L. Aaronson (Kidney Doctor / Nephrologist): Today I have the pleasure of interviewing Dr. Pierre Lavedan, MD Medical Director for palliative care and also a hospice physician for CHI Health Hospice. Thank you Doctor for joining us today.
Dr. Lavedan: My pleasure.
Dr. Aaronson: What did you do prior to becoming medical director of the palliative care service?
Dr. Lavedan: I was a family medicine doctor for 12 years. I delivered babies for 10 years. I started with hospice care about five years ago.
Dr. Aaronson: Can you define palliative care for us in layman’s terms?
Dr. Lavedan: Palliative care is attention to the patient and attention to symptoms a patient might have as the patient approaches the end of their life: We coordinate with social workers. We address the patient’s spiritual needs and work with the chaplain. We focus on treating a patient’s pain. We also take care of symptoms that take away from a patient’s comfort such as shortness of breath, nausea, vomiting, diarrhea, constipation and other issues related to pain.
But also, palliative care is meant to be given in some circumstances alongside aggressive medical therapy. So if the goal is curative, that does not exclude the use of palliative care medicine.
Dr. Aaronson: I think that’s a key take home message. To reiterate: I, as a kidney doctor, can perform dialysis, treat a patient with an intent to cure, and still use your services. The reason why I like to have palliative care involved, is that in the setting of a sick patient, sometimes curative therapy is futile, and the palliative care service can facilitate the transition from cure-focused, which may be uncomfortable, to comfort-focused which enables the patient to have dignity when they pass. You are there to help them with that transition.
Dr. Lavedan: We can also help the transition to hospice care, so a patient can be transferred out of the intensive care unit to their home or another facility.
Appropriate consultation to palliative care is the following: the diagnosis of chronic obstructive pulmonary disease or emphysema when the patient is requiring oxygen; the diagnosis of congestive heart failure; the diagnosis of kidney failure including the possible need for kidney dialysis…
Dr. Aaronson: I like to use you in this setting very often. Sometimes the decision of whether or not to perform kidney dialysis is quite complicated. I like to think of your service as a third-party independent team of people that helps the patient decide what to do. Just because dialysis is available doesn’t mean a patient has to go on it.
Dr. Lavedan: My pleasure. We can also help patients who have diabetes and are approaching end-stage. End-stage means when the diabetes is starting to affect multiple organs: heart problems, eye problems, and kidney problems. In other words, everything taken together. Sometimes, despite what we do the patient is gets worse and not better.
Dr. Aaronson: Why did you decide that palliative care was your calling?
Dr. Lavedan: I was a part of the ethics committee prior to making the change. I felt that there was a lot of misunderstanding in terms of what can or what cannot be done.
Dr. Aaronson: That’s a good point. The ethics committee is a group of people who may not be directly involved with the patient. Palliative care enables you the opportunity to discuss the situation with the patient or their proxy/durable power of health care directly.
Dr. Aaronson: I just wanted to let the public know that palliative care at Alegent health is growing at a rapid pace. Palliative care medicine is widely available.
Next question: For those who do not believe, here’s a tough one for you. Why can’t I do what you do? Why can’t the primary care provider, who has known the patient for possibly 20 or 30 years, do what you do? What makes it worthwhile to have you on board?
Dr. Lavedan: Let me give you my perspective. As a family medicine physician, I look at life from beginning to end. As a palliative care physician, I look at life from the end to where we are currently at. I do this full-time, and I look at life backwards. I have totally reoriented the way that I view life. I think about how the patient is going to progress naturally, and I do everything I can to help anticipate and control symptoms so that the patient has comfort. In order to do this, it does takes special expertise. Just like you have special skills and expertise taking care of patients with kidney problems, hypertension, and critical care issues, my expertise is palliative care and hospice care. In fact there is a board certification in palliative care that is available and that I have passed.
Our team focuses on how much time is left, how can we help the patient and the patient’s family. We also want to make sure that the patient and family address issues early so that a smooth transition can be had. This approach is much preferable to a series of emergencies.
For example, if the patient is living at home alone, is the patient doing that successfully? If you are driving, should you stop driving? If you are not living alone, if you are now living with your family because you need extra support and care, how are they doing and are they adequately planning for the time when more care is needed? If the patient’s family is not able to perform a higher level of care, then what’s the plan? Should the patient go to assisted living at this point? What about nursing home care?
Dr. Aaronson: I think that’s a great explanation. I would add that you are also a specialist in pain control. I sometimes feel a patient’s pain is under-treated, and I’m glad that you are there to take over that part of the patient’s care.
Dr. Lavedan: We also are very helpful in the setting of when a patient wants something done and the patient’s family wants something else done. We can help facilitate coming to a conclusion so that everyone is on the same page. We can help the family decide what should be done. The key here is to come at it from the point of view of what the patient wants, not what the family wants, not what the doctor wants. The focus is on what the patient wants or would want. Our goal is to try to help it all make sense.
Dr. Aaronson: What to do for fun?
Dr. Lavedan: Not a lot of time for fun. My main hobby for fun right now is sailing.
Dr. Aaronson: What you do in the winter? Do you ice fish?
Dr. Lavedan: No ice fishing. And no ice sailing — that is when the ice freezes over and people actually sail on ice. Otherwise I spend my time taking care of my family. I have three children. They keep me busy. I have a lot of school and sports activities. We are active in the school church.
Dr. Aaronson: If someone is interested in using your services, what approach should they take to get you involved?
Dr. Lavedan: Since palliative care medicine is a specialty not a primary care practice, it is proper to go through the primary care doctor. Sometimes a specialist with the blessing of the primary care physician will call us directly to let us know about the patient’s situation. Of note, we do have an outpatient clinic located at Lakeside.
Dr. Aaronson: Thank you so much for your time today. I think we’ve all learned quite a bit.
Dr. Lavedan: Thank you for the opportunity.
Dr. Aaronson: Here is the link to the palliative care website at CHI health. Thanks for listening!
These blogs are written by members of the CHI Health Nephrology team.