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When internist Stephen Bekanich, M.D., was in medical school, he wasn’t the least bit interested in palliative care. But when his grandmother endured a troubling death from metastatic breast cancer nearly a decade later, he redirected his career to the burgeoning field dedicated to relieving physical symptoms and emotional distress of seriously ill patients.
"There was a lot of aggressive care that wasn’t appropriate to the stage of her illness,” Bekanich recalls. “I felt like there was a lot of unnecessary suffering. That really changed the focus of my career.”
Indeed, his grandmother’s experience transformed Bekanich into a national authority in palliative care and recently brought him from the snowy mountains of Utah to the sunny flatlands of South Florida to serve as medical director of the new Palliative Care Services at University of Miami Hospital (UMH) and Sylvester Comprehensive Cancer Center.
The new program includes an inpatient consultation service, available at the request of attending physicians, a 10-bed hospice unit established at UMH by VITAS Innovative Hospice Care, a future clinic at Sylvester, and a VITAS-sponsored fellowship program to train the next generation of hospice and palliative care specialists.
Given the array of resources already in place, Bekanich, associate professor of medicine at UM’s Miller School of Medicine and the former medical director of Palliative Care Services at the University of Utah School of Medicine, can hardly believe his – and South Florida’s – good fortune.
"The idea of starting off with a 10-bed unit in an academic hospital is unheard of,” he says. “Usually, you start off with part-time, bare-bones staff and, as the value of the program becomes clearer, you get more resources.”
Bekanich has no doubt UM’s new service will prove its worth. After all, palliative care is known to decrease costs and increase patient satisfaction because patients who receive it often opt for interventions that help them feel better, but forego tests and treatments that will not improve outcomes.
The key, says Bekanich, is education and conversation. Palliative care specialists help patients and their families clarify treatment goals and make decisions that maximize quality of life through the progression of disease or disability. Unlike hospice care, which is geared to terminally ill patients who have less than six months to live and for whom life-prolonging treatments are no longer effective, palliative care can be appropriate at any stage of illness, for any diagnosis.
"You do not need to be actively dying or need to abandon life-prolonging therapy to be one of our patients,” Bekanich says. We’re not looking to be called in at the 11th hour. We like to see patients upstream in their illness so they have peace of mind that their symptoms are going to be paid attention to, that their family will be listened to, that their goals of care will be reviewed.”
When Bekanich’s paternal grandmother died in 2005, and he pursued training in palliative care, it was not yet a board-certified specialty. That happened a year later. Now, with people living longer and dying from cardiovascular disease and other illnesses with debilitating emotional and physical symptoms, Bekanich hopes the field will continue to grow – and change the traditional model of patient care.
"The traditional model has always been diseased-centered, not patient-centered. It’s about treating and curing the disease, and the patient just goes along for the ride,” says Bekanich, who also serves as associate editor of Fast Article Critical Summaries for Clinicians in Palliative Care, or PC-FACS, an electronic publication of the American Academy of Hospice and Palliative Medicine. "We’ve left the era where people die of trauma and infections; now they die from long-term illnesses with enormous symptom burdens, and the patient and family have to be incorporated into the way we look at the illness.”
