Their first meeting to discuss collaborating was in August 2005, and by November 15 the renovated unit was in operation, with two-room suites large enough to allow the patient’s family members to stay overnight on pullout sofas. Dr. Praszek’s name entered the dialogue after she gave a hospital lecture on end-of-life care and code status. “When we talked with her and she shared her career journey, we could see that she was a logical fit,” explains Ream. “And she really wanted to do this.
“My impression is that Dr. Praszek has a true ‘hospice heart.’ She really understands the interdisciplinary team. She’s an expert clinician, and she understands the differences in treating terminally ill patients. She has a real sense of the patient and family as people,” says Ream. “Nurses love her commitment and enthusiasm and are proud to be her colleagues.”
Dr. Praszek’s first concern is keeping people healthy. “To be a hospitalist on a hospice unit, you have to know how to change your focus from cure to caring,” she says. “It takes someone who is not afraid of confronting their patients’—or their own—mortality. When we first opened the unit, there was a sharp learning curve for physicians in the hospital. But it’s been a pretty smooth transition overall, except for one or two who still have a hard time recognizing when their patient is dying. Most physicians at this institution are learning how to look at the entire lifespan of their patients.”
Dr. Praszek tries to see every patient on the hospice unit each day she is on service. She also works closely with the interdisciplinary team at Hospice of East Texas. Routine care on the unit is provided by hospital staff, while the hospice team provides care management and oversight. Hospice care generally involves fewer intensive medical procedures and more intensive nursing care and comfort measures.
A Deeper Commitment
“My life today is the way it is because I really love my work,” says Dr. Praszek. She brings a lot of it home at night. In fact, Dr. Brown says he occasionally worries about the long hours she works. “But we try to make sure she gets the support she needs.”
“My door is always open,” adds Dr. Praszek. “I’m still learning from the nurses, and I’ve had housekeeping staff give me advice. When they find out my background [as a nurse’s aide], they always say, ‘Oh, that’s why we get along so well.’ ” TH
Larry Beresford wrote about hospitalists who work as administrators in the July issue.