The first thing Marcos Rejtman, D.O., does when he gets a new hospice patient is thoroughly assess the patients needs and medications.
“Medication reduction and careful dose titration are the most valuable things a hospice physician can do,” says Rejtman, a nursing home physician at VITAS Innovative Hospice Care® in Broward County since 2001. He won the companys prestigious national award for Team Physician of the Year in 2007.
“First and foremost, I eliminate all unnecessary meds, such as many of the ones used to treat hyperlipidemia, hyperglycemia and dementia,” continues Rejtman, a family practitioner and geriatric physician. “The risks and adverse side effects of many medications far outweigh the benefits in terminal patients.”
Once hes evaluated his patients meds, Rejtman, who is board certified in family practice, geriatric medicine and hospice and palliative care, endeavors to provide good basic medical care to his patients, noting that “good hospice care in nursing homes is good geriatric medicine.”
“Theres still a misconception that hospice is just about pushing morphine,” says Rejtman, “but a physician trained in end-of-life care knows how to use diet liberalization, environmental modifications and different medications to help patients breathe, sleep, eat and feel better.
“People are often amazed when many of our patients actually improve after admission into hospice care,” continues Rejtman. “But thats the real mission of hospice careto improve the quality of life for the amount of life that patients have left.” And thats a concept of medicine that has stuck with Rejtman since he was young.
Before Rejtman became a physician, his grandfather died after years of painful yet futile medical treatments. “In his moments of lucidity, he would sometimes beg to die,” recalls Rejtman. “Hospice was not an option at the time, so he suffered for several more years before dying. I knew there had to be something better.”
Rejtman would find that “something better” but it would take a while. He attended Nova Southeastern University (NSU) College of Osteopathic Medicine and the Philadelphia College of Osteopathic Medicine. One day in his third year of medical school, his group was released after completing internal medicine rounds because the attending physician had to make hospice rounds. At the mention of “hospice,” Rejtman asked to accompany the doctor.
“We walked into an inpatient unit where there was a young man who was obviously terminal,” says Rejtman. “He had cancer of the head and neck, and the malignancy had destroyed his face. But there was still a twinkle in his eye.
“I then noticed a straw in his mouth that lead to a can of beer,” laughs Rejtman. “I thought, So thats hospice! Cool! Just let him have his beer. Food and drink are among lifes last discretionary pleasures, so why not let dying patients have what they want?” That visit convinced Rejtman that he liked hospice medicine because “it made sense.”
Although Rejtman experienced that epiphany early in his training, he wasnt able to follow his dream until hed paid his dues. That included years of working as an emergency room and internal medicine physician, which although admirable jobs werent good fits for Rejtman.
“I had to participate in repeated code blue procedures that I viewed as cruel and futile,” he says. “The majority of ICU patients are terminal, yet millions of Medicare dollars are spent daily, subjecting them to painful treatments at the expense of their dignity and often in violation of their advance directives. I think hospice and palliative care offer a much more appropriate and humane approachbetter care at the end of life.”
Rejtman works with Medical Multi Specialty Group in Sunrise, is involved in research at the Independent Investigational Review Board and is active in medical education at NSU. But he says it is at VITAS that hes found the “perfect fit for my philosophy and temperament.” He enjoys his work and his VITAS patients are breathing easier, too.
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