From Mariah Tanious, MD, MPH, FAAP, Assistant Professor, Pediatric Anesthesiology, Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina
Thank you for including such an important topic as access to pediatric palliative care within the PAAD series (“Palliative Care Programs” 10/17/2022). This increasingly recognized aspect of pediatric care is especially relevant for us in the perioperative space, where a recent study in Pediatrics (1) found that during terminal hospitalizations, nearly half of children undergo surgery.
As a complement to these recent findings, a multidisciplinary research group of researchers at my institution is currently completing a study characterizing receipt of palliative care consultation during terminal admissions of surgical patients. As your review astutely notes, even more critical than binary presence/absence of palliative care access or the checkbox of a completed consult, our study aims to assess the relationship between receiving palliative care and patient-centered outcomes, like location of death, resuscitation measures received, consult timing relative to surgery and to death. We are fortunate to have a robust palliative care program at our children's hospital and yet preliminary data suggests there is still room for improvement in how this service is utilized and functions within the larger context of a a child's end-of-life care.
We look forward to more focus on this incredibly valuable topic and to sharing our results in the near future.
Reference: (1) Traynor, M.D., et al., Surgical Interventions During End-of-Life Hospitalizations in Children's Hospitals. Pediatrics, 2021. 148(6). PMID: 34850192
From Charles Cote MD
In response to the Oct 18th PAAD (“Charlie or King Charles: Do titles matter”). I always used to introduce my self as “Hi I’m Dr Charlie, I am your anesthesiologist, do you know what an anesthesiologist is? I’m the kind of doctor that will give you some medicine so that you can have your operation. The sleep from the anesthesia medicine is different than the sleep at home. At home if or wake up until the operation is finished. Then at the the end I will take the medicine away and you will be back with your parents.”
I also thought it was important to sit down rather than speak in the standing position as standing suggests you want to leave. I always taught this to my residents.
From Adamina Podraza MD FAAP FASA, President Illinois Society Anesthesia
After reading “Charlie or KIng Charles Do titles matter?”: I believe using your first name adds to the confusion of who is your "provider". Sadly when my patients in the OR talk about their "doctor" they don't know or understand the difference, if seeing a nurse practitioner, physician assistant or a doctor.
When my son was a medical student (Now intern) He was reprimanded by saying the "nurse" will be in to see you next (Referring to nurse practitioner) They said always say "provider" when referring to NP, Dr or PA. I believe this is totally wrong. In Illinois we fought for a law "Truth in advertising" I Illinois in a hospital or medical center you can only refer to as doctor if you are an MD, DO, podiatrist, dentist.
From Bob Spear MD
I jokingly tell people that I prefer to be called just by my first name…”Doctor”. “The Doctor” is fine too.