Building More Support into the Structure

Being precise in terminology is important to Tim Thomsen, MD. As Director of the Supportive and Palliative Care Program at University of Iowa Health Care, Dr. Thomsen has worked hard to be clear about what his team can do. “The word ‘palliative’ seems to mean ‘death’ to most doctors,” he says. “But all it really means is to relieve suffering without curing.” And when studies revealed that physicians at other institutions were more likely to refer patients for assistance with the addition of the word “Supportive” to the service’s name, Dr. Thomsen campaigned to have it added at this institution as well.


The change was not just a cosmetic rebranding. The service added two registered nurses, Carol Harshman and Margaret Schmalle, one to manage outpatient consultations, and the other for inpatients. “They are our supportive care element, helping the patient put together their care picture,” Dr. Thomsen says. “They might talk about CPR, they might identify the patient’s goals and explain what the goals of the health care system are. They listen to the patient’s frustrations, and they advocate.” Initially, their assistance went underused. But, as awareness of their existence grew, so has demand for their skills in other parts of the hospital.

Producing care that meets as many patient needs as possible has always been a part of the Supportive and Palliative Care team’s mission, even before the addition of Ms. Harshman and Ms. Schmalle. Dr. Thomsen recognizes that the institution is filled with extraordinarily talented and knowledgeable providers, but often the focus is overly narrow. “It’s easy to do things to a patient, harder to do things for a patient.” To Dr. Thomsen, the difference lies in taking the risk of asking a patient what he or she wants. “Sometimes just asking ‘How can I help you?’ can produce some critical information.” But asking that requires, in his view, being open to a wide array of responses. “Our tendency is to fall back on science.” Over the years in the role, Dr. Thomsen has grown more comfortable with responding to the patient and not the symptoms. “If someone tells you about their fear of dying . . . you have to be willing to get down to their level and hear their story and be really uncomfortable yourself.”

The goal in any interaction, Dr. Thomsen says, is to make a connection. The wide variety of team members on the service allows them a number of different avenues to form this. A social worker, a music therapist, chaplains, physicians, and pharmacists, all work together in a non-hierarchical “horizontal structure,” with the goal of helping relieve the pain of patients or family members, whatever form that might take. “It may be the music therapist who initially connects with you in a meaningful way and, by virtue of that connection, the rest of the team can start to add to that, helping you deal with your grief.”

Dr. Thomsen is pleased with the growth of the new side of the Supportive and Palliative Care Program. “Best thing we’ve done,” he says. “The question now is how to expand it.” He describes new training programs for nurses and other staff, specifically, “how to recognize the signs and symptoms of suffering and get those patients seen.” Another area he sees as a potential for growth is assisting in the Emergency Department. By helping people articulate their needs earlier, upon arrival, Dr. Thomsen hopes his team might be able to produce an even more solid foundation other providers can build on.

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