WEBVTT NOTE This file was generated by Descript 00:00:07.083 --> 00:00:09.322 Candace Dellacona: Welcome to the Sandwich Generation Survival Guide. 00:00:09.322 --> 00:00:13.962 I am your host, Candace Dellacona, and I am here today with Dr. 00:00:13.962 --> 00:00:20.992 Matthew Tyler, who is a dual certified internal medicine and palliative 00:00:20.992 --> 00:00:26.032 care doctor, and also the founder of How to Train Your Doctor, which I'm 00:00:26.032 --> 00:00:30.382 sure our listeners already know about because he has thousands of followers 00:00:30.382 --> 00:00:33.202 on Instagram, on Facebook, on YouTube. 00:00:33.502 --> 00:00:34.942 So welcome Matt. 00:00:35.982 --> 00:00:35.983 Dr. Matthew Tyler: 00:00:35.982 --> 00:00:36.712 Thank you so much for having me. 00:00:36.712 --> 00:00:37.312 It's good to be here. 00:00:37.807 --> 00:00:39.397 Candace Dellacona: It's great to have you. 00:00:39.457 --> 00:00:45.457 I just said to you before that I think I have more questions for you than I've 00:00:45.547 --> 00:00:51.697 ever had for any other podcast guests, so I'm so glad to welcome you here today. 00:00:52.057 --> 00:00:56.527 Why don't you tell our listeners a little bit about who you are and what, 00:00:56.827 --> 00:00:58.722 How to Train Your Doctor is all about. 00:00:59.802 --> 00:00:59.803 Dr. Matthew Tyler: 00:00:59.802 --> 00:01:00.192 Sure. 00:01:00.222 --> 00:01:04.212 So I am a full-time hospice and palliative care physician, 00:01:04.722 --> 00:01:07.362 and I work in the hospital. 00:01:07.362 --> 00:01:09.282 I work in our cancer treatment center. 00:01:09.982 --> 00:01:13.652 And for those of you who are unfamiliar with palliative care palliative care is 00:01:13.652 --> 00:01:19.722 a medical specialty that provides support in anything related to the stressors or 00:01:19.722 --> 00:01:24.792 symptoms related to a serious illness like cancer or heart failure or dementia. 00:01:25.452 --> 00:01:29.142 And the real big picture goal of palliative care is to give you 00:01:29.142 --> 00:01:30.642 the best quality of life possible. 00:01:31.662 --> 00:01:36.072 And so I am often meeting with families, patients, caregivers, at 00:01:36.072 --> 00:01:40.422 very difficult times in their life, faced with big decisions about medical 00:01:40.422 --> 00:01:45.222 testing, treatment interventions, which ones make sense, which ones feel 00:01:45.222 --> 00:01:47.322 like maybe they're a bridge too far? 00:01:47.952 --> 00:01:53.262 And I help function as a sounding board to make sure that these patients and 00:01:53.262 --> 00:01:55.962 their families have the information they need to make tough decisions 00:01:56.412 --> 00:02:00.462 and the emotional support to think through those help provide some. 00:02:00.897 --> 00:02:03.332 Guidance on how to make a plan to move forward. 00:02:04.392 --> 00:02:09.682 Candace Dellacona: And so how did you come to transition to find your, calling? 00:02:09.682 --> 00:02:13.722 Because, for those of you out there listening, the way that I found you, Matt, 00:02:13.752 --> 00:02:18.717 was through Instagram because you were putting out such amazing and helpful and 00:02:18.717 --> 00:02:22.737 enlightening information, even for someone who is tangentially related to this world. 00:02:23.307 --> 00:02:25.857 How did you come to How to Train Your Doctor? 00:02:25.857 --> 00:02:29.387 Tell us a little bit about that process and what you hope to do. 00:02:29.387 --> 00:02:29.388 Dr. Matthew Tyler: 00:02:29.387 --> 00:02:29.517 Yeah. 00:02:30.042 --> 00:02:35.322 So my foray into social media and talking about all topics related to 00:02:35.322 --> 00:02:41.782 palliative care came from two big issues in our field of palliative medicine. 00:02:42.252 --> 00:02:45.972 One issue is that people don't meet us early enough in their illness. 00:02:46.212 --> 00:02:51.782 Palliative care often gets called in, way too late compared to when 00:02:51.782 --> 00:02:53.087 we could provide the most support. 00:02:54.052 --> 00:02:57.862 The other observation being that even if we were getting called a hundred percent 00:02:57.862 --> 00:03:01.922 of the time the way we wish we would, there aren't enough of us to go around 00:03:02.282 --> 00:03:07.532 and you can't scale people as well as you can, scale views on social media. 00:03:07.532 --> 00:03:11.692 And so my hope by getting into social media was just to show 00:03:11.692 --> 00:03:14.632 people what palliative care is all about and how it can be helpful. 00:03:15.562 --> 00:03:18.712 The big goal that people would start to kind of speak up and ask for 00:03:18.712 --> 00:03:21.292 palliative care, demand palliative care from their medical team to be 00:03:21.382 --> 00:03:22.557 part of the support on their team. 00:03:23.372 --> 00:03:23.932 Candace Dellacona: Amazing. 00:03:23.932 --> 00:03:27.712 I recently had a guest on the podcast, and one of the topics we were talking 00:03:27.712 --> 00:03:32.452 about was the concept of supportive care, which is obviously beyond the 00:03:32.452 --> 00:03:35.692 medical treatment, let's say that someone is receiving for cancer. 00:03:36.112 --> 00:03:40.432 And so I love topics like this because it really addresses the person as a 00:03:40.432 --> 00:03:42.412 whole and often the family as a whole. 00:03:42.922 --> 00:03:45.892 I think one of the things that I've noticed with a lot of 00:03:45.892 --> 00:03:49.282 families is the confusion between palliative care and hospice. 00:03:49.612 --> 00:03:53.242 So how do you explain the difference to families and their 00:03:53.272 --> 00:03:55.702 patients about the difference? 00:03:56.112 --> 00:04:01.792 And you sort of touched on this as a two part question is how and when should 00:04:01.792 --> 00:04:04.072 the palliative care ideally begin? 00:04:04.757 --> 00:04:04.758 Dr. Matthew Tyler: 00:04:04.757 --> 00:04:10.042 Yeah, so I find easiest to differentiate palliative from hospice care in that 00:04:10.522 --> 00:04:13.712 palliative care is needs based and hospice care is prognosis based. 00:04:14.472 --> 00:04:17.952 So you are eligible for palliative care from the moment you receive 00:04:18.147 --> 00:04:20.337 a serious illness diagnosis. 00:04:20.637 --> 00:04:25.307 So the moment you're getting advanced dementia or a cancer diagnosis, if you 00:04:25.307 --> 00:04:28.727 have concerns related to the quality of your life, how treatment's gonna 00:04:28.727 --> 00:04:32.127 impact that, and how the disease is gonna treat that how well it's gonna 00:04:32.127 --> 00:04:35.577 work, how it's gonna make you feel, you're eligible for palliative care. 00:04:36.132 --> 00:04:41.342 And we have, there was a landmark study back in 2010 that showed patients 00:04:41.342 --> 00:04:45.192 who got connected with palliative care at the beginning of a stage four 00:04:45.192 --> 00:04:47.052 non-small cell lung cancer diagnosis. 00:04:47.552 --> 00:04:49.892 You know, we all sort of figured if you get connected to palliative care 00:04:49.892 --> 00:04:53.132 early, you have a better quality of life, which ended up being true. 00:04:53.412 --> 00:04:56.832 But the kicker was that those folks ended up living longer with a better 00:04:56.832 --> 00:05:00.022 quality of life with less intense treatment than the folks who got 00:05:00.022 --> 00:05:02.242 palliative care later on or never. 00:05:03.577 --> 00:05:07.477 And palliative care, again, needs based, if you have concerns about quality of 00:05:07.477 --> 00:05:11.747 life with an underlying serious illness you should be asking for palliative care. 00:05:11.747 --> 00:05:13.757 You should be expecting it, but definitely asking for it. 00:05:14.612 --> 00:05:17.297 Hospice care on the other hand is prognosis based. 00:05:17.417 --> 00:05:22.097 Meaning at the end of the day it's an insurance benefit that you are eligible 00:05:22.097 --> 00:05:27.027 to use if you have an underlying illness for which, if it runs its expected 00:05:27.027 --> 00:05:31.527 natural course, your doctor believes that your time is six months or less. 00:05:33.207 --> 00:05:37.197 Candace Dellacona: So the magic number for hospice is the anticipated 00:05:37.437 --> 00:05:40.987 expectation or prognosis of six months or less, which should be a 00:05:40.987 --> 00:05:45.007 pretty good indicator why palliative care is not the same as hospice. 00:05:45.037 --> 00:05:53.067 And so you know when you are someone who requests the palliative care piece, can 00:05:53.247 --> 00:05:59.277 a patient also be provided the curative treatments or the treatments that you 00:05:59.277 --> 00:06:01.617 had been receiving for cancer all along? 00:06:02.987 --> 00:06:02.988 Dr. Matthew Tyler: 00:06:02.987 --> 00:06:03.827 Yeah, absolutely. 00:06:03.827 --> 00:06:05.777 The best part about palliative care is that you can get it 00:06:05.777 --> 00:06:07.427 alongside all your other treatments. 00:06:07.477 --> 00:06:11.137 So as I mentioned, I take care of folks in the cancer treatment center and 00:06:11.137 --> 00:06:13.147 I'm working alongside the oncologist. 00:06:13.177 --> 00:06:16.537 They're doing the chemo, the immunotherapy, and I'm doing the 00:06:16.537 --> 00:06:19.627 symptom management, the emotional support, the planning for the future. 00:06:19.967 --> 00:06:20.897 We work together. 00:06:20.967 --> 00:06:23.877 One of my pet peeves about how people talk about palliative care is when 00:06:23.877 --> 00:06:27.567 we talk about people going palliative care or people that are in palliative 00:06:27.567 --> 00:06:32.507 care is I worry that it perpetuates a misconception that palliative 00:06:32.507 --> 00:06:35.337 care is like a choice that you have to make in lieu of something else. 00:06:35.437 --> 00:06:37.267 You don't have to give up anything to get palliative care. 00:06:37.267 --> 00:06:41.287 It's an, it's extra support and almost everyone I work with says 00:06:41.287 --> 00:06:42.577 they could use some extra support. 00:06:43.567 --> 00:06:46.387 Candace Dellacona: I think I've never heard anybody say that they're good. 00:06:46.957 --> 00:06:48.587 And they don't need that extra help. 00:06:48.587 --> 00:06:52.997 If anything, the reason why this podcast exists, the reason why your social media 00:06:52.997 --> 00:06:56.537 platform exists and it's so successful is because people are starved for 00:06:56.537 --> 00:06:58.517 resources and don't know where to begin. 00:06:58.977 --> 00:06:58.978 Dr. Matthew Tyler: 00:06:58.977 --> 00:06:59.327 Yeah. 00:06:59.327 --> 00:07:02.302 Candace Dellacona: When you think of palliative care, or maybe when I think 00:07:02.302 --> 00:07:05.042 of palliative care, I should say, and perhaps some of our listeners, 00:07:05.522 --> 00:07:11.597 you know what sort of care and things do the palliative care teams most 00:07:11.597 --> 00:07:15.257 commonly manage on behalf of a patient? 00:07:15.467 --> 00:07:17.147 Can you give us some examples? 00:07:17.672 --> 00:07:17.673 Dr. Matthew Tyler: 00:07:17.672 --> 00:07:18.062 Yeah. 00:07:18.112 --> 00:07:22.552 A standard palliative care team should include multiple disciplines on the team. 00:07:22.582 --> 00:07:27.572 Meaning docs, nurses, social workers, chaplains, ideally. 00:07:28.172 --> 00:07:31.442 And so how palliative care can help will depend on, who amongst 00:07:31.442 --> 00:07:32.762 the team you're working with. 00:07:32.792 --> 00:07:37.582 But high level palliative care should be able to provide some insight and 00:07:37.582 --> 00:07:41.992 guidance on how to manage you know, physical symptoms, emotional needs, how 00:07:41.992 --> 00:07:45.872 you're coping with things, your kind of spiritual and existential things like how 00:07:45.872 --> 00:07:49.112 this illness is kind of impacting how you see yourself in the world, the universe, 00:07:49.112 --> 00:07:50.972 and think about the bigger picture. 00:07:51.522 --> 00:07:55.002 They can also help with planning for the future, getting your wishes in writing, if 00:07:55.002 --> 00:07:56.047 you would find that sort of thing helpful. 00:07:56.872 --> 00:07:59.572 Talking to your family about what's going on, kinda getting them to rally 00:07:59.572 --> 00:08:03.202 behind your wishes and coordinating care with the other medical specialists 00:08:03.202 --> 00:08:06.412 and making sure that we are all on the same page about what we're doing and 00:08:06.412 --> 00:08:07.767 why we're doing it, what to expect. 00:08:08.632 --> 00:08:08.962 Candace Dellacona: Yeah. 00:08:09.442 --> 00:08:14.652 And why do you think there seems to be, aside from, let's say staffing issues 00:08:14.652 --> 00:08:17.842 and the fact there are not enough palliative care team members to go 00:08:17.842 --> 00:08:23.182 around, what is the resistance or the perceived resistance would you say among 00:08:23.392 --> 00:08:28.672 other professionals and among families when it comes to like this dialogue 00:08:28.672 --> 00:08:30.682 and why is there so much confusion? 00:08:30.682 --> 00:08:33.922 Do you, you thought about where that's come from? 00:08:34.612 --> 00:08:34.613 Dr. Matthew Tyler: 00:08:34.612 --> 00:08:36.492 Obsessively yeah how long we got. 00:08:36.592 --> 00:08:36.832 Candace Dellacona: Exactly. 00:08:37.492 --> 00:08:37.493 Dr. Matthew Tyler: 00:08:37.492 --> 00:08:42.202 I think there's a lot of pieces to the access to care issues when it comes 00:08:42.202 --> 00:08:45.662 to palliative care and connecting when we should be connecting. 00:08:46.212 --> 00:08:49.242 Part of that is that palliative care did, at its core, come 00:08:49.242 --> 00:08:50.472 from the Hospice movement. 00:08:50.482 --> 00:08:51.852 Hospice was here first. 00:08:51.862 --> 00:08:55.752 The modern day hospice came about from, at least in the US the Reagan era. 00:08:55.782 --> 00:09:00.082 Hospice as a philosophy goes back much further, but the Medicare hospice 00:09:00.082 --> 00:09:02.152 benefit was a Reagan era thing. 00:09:02.202 --> 00:09:05.672 Candace Dellacona: Identified during the 1980s for purposes of 00:09:05.672 --> 00:09:10.492 hospitals getting paid or care providers getting paid for the care 00:09:10.492 --> 00:09:12.322 provided under the hospice umbrella. 00:09:12.662 --> 00:09:12.663 Dr. Matthew Tyler: 00:09:12.662 --> 00:09:13.072 Right. 00:09:13.242 --> 00:09:13.452 Right. 00:09:13.492 --> 00:09:13.812 Candace Dellacona: Okay. 00:09:14.352 --> 00:09:14.353 Dr. Matthew Tyler: 00:09:14.352 --> 00:09:18.132 And palliative care as a board certified medical specialty is even newer. 00:09:18.232 --> 00:09:22.072 Again, people were doing palliative care and providing patient-centered 00:09:22.072 --> 00:09:24.472 holistic support for a very long time. 00:09:24.522 --> 00:09:28.522 But as a board certified specialty that didn't come about 2008. 00:09:29.442 --> 00:09:29.872 Candace Dellacona: Wow. 00:09:29.902 --> 00:09:31.552 Okay, so it's really new. 00:09:31.867 --> 00:09:31.868 Dr. Matthew Tyler: 00:09:31.867 --> 00:09:32.377 Yeah. 00:09:32.377 --> 00:09:32.797 It is new. 00:09:32.797 --> 00:09:36.487 And with that comes the, there's we're kind of in between generations 00:09:36.537 --> 00:09:38.157 of medical people right now. 00:09:38.157 --> 00:09:41.157 And there, there are doctors practicing right now that just straight up 00:09:41.157 --> 00:09:44.827 didn't have exposure to palliative care when they're in training. 00:09:45.327 --> 00:09:47.367 And again, that's a factor, not an excuse. 00:09:47.467 --> 00:09:49.957 I think we've caught up with lots of other innovations in medicine 00:09:49.957 --> 00:09:52.227 and that were a lot newer than 2008. 00:09:52.227 --> 00:09:53.457 So there's it's a piece. 00:09:53.557 --> 00:09:57.657 I think there is a, palliative care, being tied to hospice care in the name right. 00:09:57.657 --> 00:10:00.177 I'm board certified in Hospice and palliative Medicine. 00:10:00.657 --> 00:10:04.197 So there is that by tying them together, there's this conception that they 00:10:04.197 --> 00:10:08.487 must be relatively the same thing, and that can be a barrier to understanding 00:10:08.487 --> 00:10:10.587 that they're similar but not the same. 00:10:11.157 --> 00:10:15.897 And then you've got just a general cultural barriers that no one 00:10:15.897 --> 00:10:19.797 really wants to think about, talk about death and dying. 00:10:19.797 --> 00:10:22.437 It's still heavily stigmatized. 00:10:22.837 --> 00:10:25.867 It's not really something people are quite proactive about. 00:10:25.867 --> 00:10:29.382 It's something that we just sorta keep to the side until we absolutely need to. 00:10:29.617 --> 00:10:33.337 So there's not a lot of hunger in the general population to necessarily get 00:10:33.337 --> 00:10:34.747 ahead of this and learn about this. 00:10:35.087 --> 00:10:37.547 Although I think that's changing, but it's certainly a barrier for many. 00:10:38.627 --> 00:10:40.777 Candace Dellacona: So, going back to like your first point, right? 00:10:40.777 --> 00:10:45.427 When it comes to the actual care providers, if they are, esteemed enough 00:10:45.697 --> 00:10:49.277 and have enough years under their belt, it was not part of their medical training. 00:10:49.527 --> 00:10:49.528 Dr. Matthew Tyler: 00:10:49.527 --> 00:10:49.627 Right. 00:10:49.727 --> 00:10:53.237 Candace Dellacona: And so when you think about that from a caregiver's perspective 00:10:53.237 --> 00:10:57.837 or our sandwich generation members that are listening that are at the bit to 00:10:57.837 --> 00:11:01.647 get these questions answered because I know they struggle with these things. 00:11:01.947 --> 00:11:07.707 When you have a care team that perhaps doesn't have the training on it. 00:11:07.947 --> 00:11:12.247 How do you suggest they bring the subject up with the care team? 00:11:12.247 --> 00:11:17.617 Do they just say, I want a palliative care consultation with the team 00:11:17.617 --> 00:11:19.267 that must be here at the hospital? 00:11:20.472 --> 00:11:20.473 Dr. Matthew Tyler: 00:11:20.472 --> 00:11:21.282 That's where I'd start. 00:11:21.282 --> 00:11:21.492 Yeah. 00:11:21.492 --> 00:11:25.062 To say I'd like a referral to palliative care if you are taking care of someone 00:11:25.062 --> 00:11:28.512 who is in the hospital asking, do you have a palliative care team here? 00:11:28.512 --> 00:11:29.712 If so, i'd meet them. 00:11:29.792 --> 00:11:31.232 That's all you should have to do. 00:11:31.542 --> 00:11:34.722 If you're meeting with your doctor in clinic, asking for a referral 00:11:34.722 --> 00:11:38.652 to a nearby palliative care team would be a great place to start. 00:11:39.292 --> 00:11:42.007 Candace Dellacona: And I think it's important to think about too, is 00:11:42.007 --> 00:11:44.197 that's a big piece of advocacy, right? 00:11:44.247 --> 00:11:47.637 Particularly if the patient, him or herself or themselves cannot 00:11:47.637 --> 00:11:51.427 articulate things like that or it's something that they perhaps 00:11:51.427 --> 00:11:53.077 haven't thought about independently. 00:11:53.527 --> 00:11:58.092 And the other thing you brought up is that even your title saying that you're 00:11:58.092 --> 00:12:03.112 board certified in palliative care and hospice, and tying it together with 00:12:03.112 --> 00:12:05.542 that moniker and the stigma of that. 00:12:05.792 --> 00:12:10.652 How do you see your role as a practitioner to untangle that, 00:12:10.682 --> 00:12:12.722 to take the stigma out of it? 00:12:12.802 --> 00:12:17.182 I think you're doing it by, by being out there every day on your 00:12:17.182 --> 00:12:19.282 How to Train Your Doctor platform. 00:12:19.282 --> 00:12:22.852 But are there other things that you're doing that you see in your 00:12:22.852 --> 00:12:26.842 everyday life, either with patients or your colleagues about trying to un 00:12:26.902 --> 00:12:29.002 unravel that for them and unpack it? 00:12:31.052 --> 00:12:31.053 Dr. Matthew Tyler: 00:12:31.052 --> 00:12:34.457 So we're speaking specifically about stigma amongst medical professionals? 00:12:34.827 --> 00:12:35.167 Candace Dellacona: Yeah. 00:12:35.167 --> 00:12:40.672 And stigma among the moniker of like palliative care and hospice tied together. 00:12:40.822 --> 00:12:43.612 So like to the outside world, whether you're the patient or you're another 00:12:43.612 --> 00:12:46.882 professional that maybe hasn't been trained in it or resistant to it, or 00:12:46.882 --> 00:12:50.452 you're so focused on curing, you don't wanna think about things like that. 00:12:51.512 --> 00:12:51.513 Dr. Matthew Tyler: 00:12:51.512 --> 00:12:54.552 I think about that in the same way or if you're familiar with 00:12:54.582 --> 00:12:56.022 the innovation adoption curve. 00:12:56.052 --> 00:12:57.372 Are you familiar with that term? 00:12:57.402 --> 00:12:59.692 So there's this concept of a bell curve, right? 00:12:59.692 --> 00:13:03.552 You've got the early adopters, the folks that sort of follow behind when 00:13:03.552 --> 00:13:05.112 someone else has shown this is a thing. 00:13:05.412 --> 00:13:09.087 And then you've got the folks who are you're never gonna do the new thing. 00:13:09.117 --> 00:13:11.067 And you think about like telephones, right? 00:13:11.117 --> 00:13:14.567 You got the folks out there the proud few or the first ones in 00:13:14.567 --> 00:13:16.097 line for the very first iPhone. 00:13:16.607 --> 00:13:19.787 You've got the rest of us that maybe by like the iPhone four or five or six 00:13:19.787 --> 00:13:23.597 were like, oh, maybe this is gonna be a thing and maybe get rid of my Blackberry. 00:13:23.597 --> 00:13:25.577 And then we followed suit at that point. 00:13:25.692 --> 00:13:28.002 And then you got those folks who, if they still sold them, 00:13:28.002 --> 00:13:29.082 they would have a rotary phone. 00:13:29.182 --> 00:13:32.012 And I use the same concept when thinking about palliative 00:13:32.012 --> 00:13:33.867 care that's in my practice. 00:13:33.867 --> 00:13:38.437 Going through the work in the hospital and the clinic, I am looking for the 00:13:38.437 --> 00:13:43.577 folks who get it and that really don't need rigorous convincing education 00:13:43.577 --> 00:13:46.917 that this just inherently a good thing and that this is, by all metrics, 00:13:46.937 --> 00:13:49.007 standard of care in many respects now. 00:13:49.697 --> 00:13:52.282 And I reach out to them and say, how can I help? 00:13:52.282 --> 00:13:54.112 And how can we do more work together? 00:13:54.252 --> 00:14:00.432 A great example at our hospital was that we started as a hospital based team only. 00:14:00.432 --> 00:14:04.272 We were only seeing folks in the hospital to talk about symptom 00:14:04.272 --> 00:14:07.392 management, care goals, care coordination, that sort of thing. 00:14:07.942 --> 00:14:11.572 And the oncology group came to us and said, we love how you're taking 00:14:11.572 --> 00:14:13.252 care of our patients in the hospital. 00:14:14.017 --> 00:14:17.977 We would love it even more if you came to clinic and saw our patients in clinic too. 00:14:18.187 --> 00:14:19.117 Tell us what you need. 00:14:19.117 --> 00:14:20.107 We'll make it happen. 00:14:20.407 --> 00:14:21.037 Candace Dellacona: Wow. 00:14:21.127 --> 00:14:21.128 Dr. Matthew Tyler: 00:14:21.127 --> 00:14:24.907 And yeah, there was no doors needed to be beaten down at all. 00:14:24.907 --> 00:14:25.507 They saw the work. 00:14:25.537 --> 00:14:28.327 They got the work, and so we said, yeah we're there. 00:14:28.327 --> 00:14:29.407 Let's figure this out. 00:14:29.647 --> 00:14:35.127 It, meanwhile we got, residents coming to me once a week at least saying, 00:14:35.127 --> 00:14:38.502 so-and-so primary care doctor oh, we've been trying to convince them 00:14:38.502 --> 00:14:39.522 to get a palliative care referral. 00:14:39.522 --> 00:14:40.392 They just won't do it. 00:14:40.392 --> 00:14:44.392 I'm like, I say, okay, like there's just some folks that's at some point we 00:14:44.392 --> 00:14:46.302 move from, can't get it, won't get it. 00:14:46.302 --> 00:14:49.607 You've done the education you've given the talks, you've given the grand rounds. 00:14:49.607 --> 00:14:55.032 I've done all that and at some point folks just don't want to practice a 00:14:55.032 --> 00:14:59.502 different way, and there's only so much you can do so I'm always one that 00:14:59.502 --> 00:15:01.392 believes in you lean into your champions. 00:15:01.392 --> 00:15:01.902 Grow. 00:15:02.112 --> 00:15:04.767 Grow with the people that you know wanna grow with you and the will follow. 00:15:05.457 --> 00:15:07.437 Candace Dellacona: Yeah, I mean, I think that's good advice. 00:15:07.437 --> 00:15:11.297 And when you think about, the family in general. 00:15:11.327 --> 00:15:15.397 Aside from the practitioner's perspective, a lot of things that 00:15:15.397 --> 00:15:21.637 families struggle with in the context of the medical world and as advocates in 00:15:21.637 --> 00:15:25.447 the sandwich of the sandwich generation is communication and decision making. 00:15:26.027 --> 00:15:31.027 And that's in a bit of my wheelhouse when it comes to signing documents where you're 00:15:31.027 --> 00:15:36.847 appointing people to make decisions, and I know that families often feel really 00:15:36.847 --> 00:15:39.217 overwhelmed by medical information. 00:15:39.487 --> 00:15:43.537 Just in general, the diagnosis and what to do and what comes next and what 00:15:43.867 --> 00:15:48.067 should happen and what could happen if this doesn't work, kind of thing. 00:15:48.067 --> 00:15:52.927 So how do you see or what do you do with respect to your palliative care 00:15:52.927 --> 00:16:00.772 team to help the patients clarify what their goals are, if they have 00:16:00.772 --> 00:16:02.302 a hard time communicating that? 00:16:02.352 --> 00:16:03.222 Do you have any advice for that? 00:16:04.647 --> 00:16:04.648 Dr. Matthew Tyler: 00:16:04.647 --> 00:16:05.157 Yeah. 00:16:05.167 --> 00:16:09.227 And it's I'm glad you asked this 'cause this sort of reflects how, 00:16:10.247 --> 00:16:13.357 what, How to Train Your Doctor means to me compared to when I started this. 00:16:13.357 --> 00:16:19.167 So I, I started doing social media and videos back in 2022 under the 00:16:19.167 --> 00:16:20.457 handle How to Train Your Doctor. 00:16:20.457 --> 00:16:26.187 And at the time I was very much focused on giving patients and caregivers like 00:16:26.337 --> 00:16:31.567 phrases or questions to bring to the medical team to be better self advocates, 00:16:31.567 --> 00:16:33.997 engage in these complex conversations. 00:16:34.507 --> 00:16:37.762 And I, I love the idea of it. 00:16:37.952 --> 00:16:41.572 But I was repeatedly hearing from folks, Hey I'm asking for this stuff. 00:16:41.572 --> 00:16:44.122 I'm asking my doctor to have a bigger picture conversation. 00:16:44.122 --> 00:16:47.572 They keep shutting it down what am I supposed to do? 00:16:47.752 --> 00:16:52.097 And after hearing about enough, I've shifted really what I'm trying to 00:16:52.772 --> 00:16:55.532 Candace Dellacona: What are, so what were the conversation starters? 00:16:55.532 --> 00:16:59.402 So tell us a little bit about your tips that you'd provide to those people. 00:17:00.692 --> 00:17:00.693 Dr. Matthew Tyler: 00:17:00.692 --> 00:17:04.892 Yeah so the training got back to the notion that, as we talked about palliative 00:17:04.892 --> 00:17:09.542 care being relatively new in the medical field, so to our complex medical 00:17:09.542 --> 00:17:11.432 decision making communication skills. 00:17:12.012 --> 00:17:17.412 And the reality is doctors don't get trained in complex medical communication. 00:17:17.752 --> 00:17:20.392 We get trained in complex diagnoses and treatment, 00:17:20.437 --> 00:17:21.937 Candace Dellacona: In treatment, yeah. 00:17:22.102 --> 00:17:22.103 Dr. Matthew Tyler: 00:17:22.102 --> 00:17:27.022 making difficult decisions that don't have a medically speaking black 00:17:27.022 --> 00:17:28.582 and white, right or wrong answer. 00:17:29.032 --> 00:17:32.452 Medical decisions that are highly dependent on patient preferences 00:17:32.662 --> 00:17:35.422 and trade offs they're willing to make or not make as human beings. 00:17:35.822 --> 00:17:36.782 We're not trained in that. 00:17:36.912 --> 00:17:37.992 That it is happening. 00:17:37.992 --> 00:17:40.062 I think the younger generation of doctors coming through are 00:17:40.062 --> 00:17:41.592 getting exposed to more of that. 00:17:41.962 --> 00:17:44.662 But it's still more of the exception, not the norm. 00:17:45.682 --> 00:17:49.282 And again, I promise I'll answer your question when I talk about training, 00:17:50.317 --> 00:17:53.077 when I talk about How to Train Your Doctor, it was more with that in mind 00:17:53.077 --> 00:17:57.017 where I was trying to help patients and their caregivers nudge their doctors 00:17:57.017 --> 00:18:00.137 into these conversations, knowing that doctors weren't really taught 00:18:00.167 --> 00:18:02.417 how to initiate those necessarily. 00:18:02.432 --> 00:18:02.732 Candace Dellacona: Yeah. 00:18:02.732 --> 00:18:05.462 So the burden on the family or the patient really. 00:18:06.522 --> 00:18:06.523 Dr. Matthew Tyler: 00:18:06.522 --> 00:18:08.452 For a lack of any better alternative 00:18:08.602 --> 00:18:09.622 Candace Dellacona: all due respect, right? 00:18:09.652 --> 00:18:09.653 Dr. Matthew Tyler: 00:18:09.652 --> 00:18:09.982 Yeah. 00:18:10.812 --> 00:18:13.692 We can't snap our fingers and kind of change the medical culture. 00:18:14.272 --> 00:18:14.762 Candace Dellacona: no, of course not. 00:18:14.772 --> 00:18:14.773 Dr. Matthew Tyler: 00:18:14.772 --> 00:18:18.282 Uh, And a lot of patients and caregivers presume that if there 00:18:18.282 --> 00:18:20.232 was something serious to talk about, their doctor would bring it up. 00:18:20.487 --> 00:18:20.847 Candace Dellacona: True. 00:18:20.907 --> 00:18:21.497 Absolutely true. 00:18:21.497 --> 00:18:21.498 Dr. Matthew Tyler: 00:18:21.497 --> 00:18:23.597 And that is sometimes true but not always true. 00:18:23.747 --> 00:18:28.307 And in many times, the doctors look into the patients and their caregivers 00:18:28.307 --> 00:18:31.727 to float out big questions before they, they jump in because they're 00:18:31.727 --> 00:18:34.217 worried about upsetting them or giving them too much more, too much 00:18:34.277 --> 00:18:35.177 Candace Dellacona: so interesting. 00:18:35.447 --> 00:18:39.627 It's just to go back to that so if you think about it in practical sense, and 00:18:39.627 --> 00:18:45.817 I've been there as a family member we're like relying on the doctors to be telling 00:18:45.817 --> 00:18:47.437 us like, okay, what does this mean? 00:18:47.437 --> 00:18:51.067 And then the doctors are waiting us on us to ask those big questions. 00:18:51.487 --> 00:18:56.087 And often both parties walk away okay, as the caregiver or the advocate, I 00:18:56.087 --> 00:19:00.047 guess if they thought I needed to know something, the doctor would've told me. 00:19:00.317 --> 00:19:04.227 And then the doctor leaves the meeting saying if they had questions about what 00:19:04.227 --> 00:19:05.757 this meant, they probably would've asked. 00:19:05.757 --> 00:19:07.077 That, that's sort of what you're saying. 00:19:07.377 --> 00:19:07.378 Dr. Matthew Tyler: 00:19:07.377 --> 00:19:07.797 Yeah. 00:19:08.187 --> 00:19:12.157 So the early mission of How to Train Your Doctor was, prompting patients and 00:19:12.157 --> 00:19:15.597 caregivers to say, Hey, doc a quality of life is really important to me and 00:19:15.597 --> 00:19:19.522 I'd like to talk more about how this illness is gonna impact my quality of 00:19:19.522 --> 00:19:21.262 life and what changes should I expect? 00:19:21.262 --> 00:19:23.032 What decisions should I prepare for? 00:19:23.452 --> 00:19:26.692 Let's talk about getting a backup decision maker in writing. 00:19:27.142 --> 00:19:28.852 I'd really like to know about prognosis. 00:19:28.852 --> 00:19:32.062 Can you gimme some, a general ballpark about what to expect? 00:19:32.162 --> 00:19:36.662 And it was, and I think I was offering those questions through the lens, through 00:19:36.662 --> 00:19:40.662 the personal lens that if someone asked me those questions, I would love to engage 00:19:40.662 --> 00:19:42.282 with them in a conversation about that. 00:19:42.282 --> 00:19:44.532 And I'd have thoughtful answers to hope. 00:19:44.562 --> 00:19:48.282 Hopefully I'd have thoughtful answers to give them in exchange for sticking 00:19:48.282 --> 00:19:49.842 their neck out there to ask those things. 00:19:50.242 --> 00:19:52.612 Candace Dellacona: As a trained palliative care doctor though, so you 00:19:52.612 --> 00:19:56.892 were much more, you had the faculty to answer those direct questions, 00:19:56.892 --> 00:19:59.022 whereas other physicians, perhaps not. 00:20:00.312 --> 00:20:00.702 Yeah. 00:20:00.872 --> 00:20:00.873 Dr. Matthew Tyler: 00:20:00.872 --> 00:20:03.212 And at the same time, knowing that a lot of my colleagues were not 00:20:03.212 --> 00:20:07.112 powertrain, are still, willing to jump into those conversations when prompted. 00:20:07.162 --> 00:20:08.892 But at the same time there's a lot who aren't. 00:20:09.172 --> 00:20:13.912 And when do caregivers and families and patients stick their 00:20:13.912 --> 00:20:15.262 necks out to ask the questions? 00:20:15.262 --> 00:20:15.952 They really do just. 00:20:16.642 --> 00:20:17.392 Get shot down. 00:20:17.392 --> 00:20:19.112 Like, I don't talk about that, or don't worry about that. 00:20:19.112 --> 00:20:22.972 One day at a time, just like garbage like that is not particularly helpful. 00:20:23.072 --> 00:20:27.672 And so over time I've really shifted like the training of How to Train Your 00:20:27.672 --> 00:20:32.907 Doctor that I really am speaking to these days is more so just getting the 00:20:32.997 --> 00:20:36.147 palliative care referral from your doctor and training them to reach for palliative 00:20:36.147 --> 00:20:38.187 care and to pull 'em onto your team. 00:20:38.517 --> 00:20:42.807 Because that team is equipped to talk about the hard stuff and synthesize the 00:20:42.807 --> 00:20:47.127 information and put it into the context of what matters most to you and help you plan 00:20:47.127 --> 00:20:51.577 for the future to keep you in the driver's seat of your life for as long as possible. 00:20:51.577 --> 00:20:57.057 And that's really become, I think A more realistic and B, easier for 00:20:57.057 --> 00:21:00.547 people to wrap their arms around when they're already, neck deep and medical 00:21:00.547 --> 00:21:02.287 life as it is and dealing illness. 00:21:03.027 --> 00:21:05.857 Candace Dellacona: But I think what you've done with How to Train Your Doctor is, a 00:21:05.857 --> 00:21:10.037 movement by groundswell, which is, maybe it wasn't the most efficient way to try 00:21:10.037 --> 00:21:12.707 to have the other practitioners step in. 00:21:13.137 --> 00:21:16.347 But putting that information out there, you're creating more 00:21:16.347 --> 00:21:18.837 educated patients and families. 00:21:19.107 --> 00:21:23.807 So I think by virtue those, the doctors who are perhaps behind the eight ball 00:21:23.807 --> 00:21:28.587 a bit will be brought up alongside with everyone else, and hopefully 00:21:28.587 --> 00:21:30.237 there'll be some catch up there. 00:21:30.727 --> 00:21:34.087 Communication is so important with decisions like this. 00:21:34.087 --> 00:21:37.377 And one of the things that I talk about with clients when we're 00:21:37.377 --> 00:21:40.377 signing, let's say healthcare proxies, for example, here in New York. 00:21:40.777 --> 00:21:44.287 You're only allowed to appoint one agent and then one successor agent. 00:21:44.287 --> 00:21:48.007 You can't have two agents because in the event of a disagreement, 00:21:48.067 --> 00:21:49.477 what do doctors do, right? 00:21:49.477 --> 00:21:55.747 So how do you help family members when, you know there's conflict? 00:21:56.127 --> 00:22:02.687 And do you have suggestions to help families navigate these really difficult 00:22:02.687 --> 00:22:07.637 situations where some loved ones may disagree about the type of care 00:22:07.637 --> 00:22:11.617 being received, let's say medicine to manage pain, but the patient 00:22:11.617 --> 00:22:13.537 isn't alert or something like that. 00:22:13.537 --> 00:22:17.137 Do you have any suggestions for those folks out there looking for that? 00:22:17.857 --> 00:22:17.858 Dr. Matthew Tyler: 00:22:17.857 --> 00:22:22.927 Yeah, so navigating family disagreements about how to proceed with medical care. 00:22:22.977 --> 00:22:26.577 I'll say, there's always gonna be fringe cases. 00:22:26.657 --> 00:22:30.857 I'll answer this from the lens of my experience that most family members, 00:22:30.857 --> 00:22:34.067 even when they disagree, they're advocating for their loved one, the 00:22:34.067 --> 00:22:38.072 best way that they know how, and that we all have our loved one's best interest 00:22:38.072 --> 00:22:41.282 at heart when we into these conflicts and that's why they get so heated. 00:22:41.612 --> 00:22:45.122 Putting aside all the sheisty stuff we've seen about financial conflicts 00:22:45.122 --> 00:22:49.112 of interest, 'cause I think those are far away minority cases compared 00:22:49.112 --> 00:22:52.562 to what's usually going on, which is people are scared, people are confused, 00:22:52.562 --> 00:22:55.397 they're not medically trained, and they're just trying their best. 00:22:55.907 --> 00:23:00.497 Uh, and in those situations, I think what is the most helpful 00:23:00.497 --> 00:23:03.477 starting point is requesting a family meeting from the medical team. 00:23:03.667 --> 00:23:06.917 It's much easier to do in the hospital, but you can organize it in clinic too. 00:23:06.917 --> 00:23:09.767 But really setting aside a time to have everyone who has a vested 00:23:09.767 --> 00:23:13.007 interest in this medical care plan on the family side, medical side. 00:23:13.352 --> 00:23:15.962 To really sit down and make sure that we're all operating 00:23:15.962 --> 00:23:16.982 from the same playbook. 00:23:17.012 --> 00:23:18.152 What is going on? 00:23:18.492 --> 00:23:20.862 What changes are common with the disease? 00:23:20.862 --> 00:23:22.452 What decisions are on the table? 00:23:22.782 --> 00:23:26.142 And also what are the expectations from these different interventions? 00:23:26.202 --> 00:23:30.012 Do we have the same information about how feeding tubes help or hurt 00:23:30.062 --> 00:23:31.802 folks with dementia, for example? 00:23:32.192 --> 00:23:35.582 Yeah we're pushing mom to do chemo, but is the oncologist even offering chemo? 00:23:35.582 --> 00:23:39.227 Let's sort this out first and let's sort out what they think about the 00:23:39.227 --> 00:23:41.417 benefits or not of said treatments? 00:23:41.937 --> 00:23:46.827 And I would say most of the time when we have to just gather in one room or 00:23:47.397 --> 00:23:53.337 whether that be physically or virtually and have one conversation, most of this 00:23:53.787 --> 00:23:55.897 confusion and disagreement dissipates. 00:23:56.557 --> 00:23:59.617 Beyond that, as often as I can, I try to bring back the patient 00:23:59.617 --> 00:24:01.087 voice into the conversation. 00:24:01.117 --> 00:24:04.417 And if the patient can't speak for themselves, I think there is a common 00:24:04.417 --> 00:24:07.807 trap question that medical folks will ask or that families will ask of 00:24:07.807 --> 00:24:10.307 themselves, which is, what would mom want? 00:24:10.337 --> 00:24:11.327 What would dad want? 00:24:11.537 --> 00:24:16.637 And I think that is a very sticky question because when you're very sick, 00:24:16.887 --> 00:24:21.652 even dying, what most people would say they want is to get better, be stronger, 00:24:21.717 --> 00:24:22.257 Candace Dellacona: Yeah. 00:24:22.617 --> 00:24:23.247 Yeah. 00:24:23.262 --> 00:24:23.263 Dr. Matthew Tyler: 00:24:23.262 --> 00:24:24.192 go back home. 00:24:24.882 --> 00:24:28.282 And it leads us down this road of, talking about things that aren't really 00:24:28.282 --> 00:24:32.352 possible and sidesteps needing to make some really difficult decisions. 00:24:33.222 --> 00:24:36.882 And what we really need to do in these sorts of situations where this 00:24:36.882 --> 00:24:40.852 disagreement is come back to the person and their core values and how they 00:24:40.852 --> 00:24:43.962 prioritize what's most important to them. 00:24:44.652 --> 00:24:47.532 And so rather than asking, what would mom want, what would dad want, I'd 00:24:47.532 --> 00:24:50.582 say, if your dad could, understand the situation as we've laid it 00:24:50.582 --> 00:24:52.472 out to you, what would they say? 00:24:53.402 --> 00:24:55.352 Tell me what they'd say about what's going on here. 00:24:56.492 --> 00:25:01.757 And, yeah, because it really, I think we get much too fixate on outcomes and 00:25:01.757 --> 00:25:07.727 choices before spending some time with values and priorities and the process 00:25:07.727 --> 00:25:10.397 of just prioritizing what matters most. 00:25:11.027 --> 00:25:14.807 And if we spend some time talking about what matters most to this person, trade 00:25:14.807 --> 00:25:18.857 offs to be willing to make or not make for more time and what to do next is 00:25:18.857 --> 00:25:21.017 gonna be a lot easier to sort out. 00:25:21.077 --> 00:25:26.207 And again, conflict is, tends to dissipate a lot more once we start 00:25:26.207 --> 00:25:28.997 with, okay, medically, what's possible? 00:25:28.997 --> 00:25:29.957 What are the trade offs here? 00:25:29.957 --> 00:25:32.522 And then what trade offs is this person willing to make? 00:25:32.522 --> 00:25:33.752 What would they say about this? 00:25:33.977 --> 00:25:34.847 Candace Dellacona: Right, right. 00:25:35.127 --> 00:25:40.077 I think, you bring up a really great point about what would mom or dad say about 00:25:40.077 --> 00:25:44.267 this and when I have clients sign their advanced directives from a healthcare 00:25:44.267 --> 00:25:48.977 perspective, one of the questions I ask them when they're considering certain 00:25:48.977 --> 00:25:53.477 agents to be the one to speak for them is, I wanna make sure that the person you're 00:25:53.477 --> 00:25:58.487 appointing is a good advocate for you and not a shrinking violet with doctors. 00:25:58.487 --> 00:26:00.077 And can ask for the attention. 00:26:00.432 --> 00:26:05.832 But not so strong that they are substituting their wishes 00:26:05.832 --> 00:26:07.272 for the patient's wishes. 00:26:07.692 --> 00:26:09.142 And that's what you said. 00:26:09.142 --> 00:26:10.972 And there's a real balance there, right? 00:26:10.972 --> 00:26:14.712 Between advocating and being super strong and then maybe shutting out the 00:26:14.712 --> 00:26:18.372 voice of the patient and always going back to what does the patient want? 00:26:19.112 --> 00:26:19.113 Dr. Matthew Tyler: 00:26:19.112 --> 00:26:23.582 Yeah I was just the other day talking to a patient who was thinking about 00:26:23.612 --> 00:26:26.852 changing the names on their healthcare Power of Attorney document, and 00:26:26.852 --> 00:26:30.752 they had their sister on there and they were like my sister lives outta 00:26:30.752 --> 00:26:35.177 state, so I think I might I pick this friend who lives close by instead to 00:26:35.177 --> 00:26:36.257 be my healthcare private attorney. 00:26:36.972 --> 00:26:40.812 And I said look, it's certainly, it's helpful to have a healthcare 00:26:40.812 --> 00:26:43.992 surrogate who is available locally and could come to the hospital. 00:26:43.992 --> 00:26:49.362 God forbid you're hospitalized, but far more important to have a backup medical 00:26:49.362 --> 00:26:53.732 decision maker who just understands your values and your priorities and 00:26:53.732 --> 00:26:58.892 step up to make potentially like really high stakes life or death decisions. 00:26:59.072 --> 00:27:03.692 Because it's your POA, your power of attorney, is rarely ever making 00:27:04.202 --> 00:27:06.302 easy decisions or low stakes things. 00:27:06.302 --> 00:27:10.202 It's when you're so sick that we need to have a thoughtful conversation about, 00:27:10.542 --> 00:27:14.922 quality of life versus living as long as possible and different decisions. 00:27:14.922 --> 00:27:16.962 Those are the things that power of attorney most 00:27:16.962 --> 00:27:18.342 commonly gets called in to do. 00:27:18.342 --> 00:27:22.982 So ideally, pick someone who can speak as if they were you and will, speak 00:27:22.982 --> 00:27:24.482 up to make tough decisions if need be. 00:27:25.122 --> 00:27:27.462 Candace Dellacona: And just for clarification purposes, so you're in 00:27:27.462 --> 00:27:32.012 the Midwest and so in some states in the Midwest healthcare directives are 00:27:32.012 --> 00:27:36.242 called medical or healthcare powers of attorney Here on the East Coast, they're 00:27:36.242 --> 00:27:38.342 mostly referred to as healthcare proxies. 00:27:38.342 --> 00:27:41.222 When Matt is referring to a power of attorney making a decision 00:27:41.222 --> 00:27:43.802 for medical purposes, it's a medical power of attorney. 00:27:44.312 --> 00:27:46.522 And one of the things that you said at the top of. 00:27:47.077 --> 00:27:51.337 Our discussion was talking about the spiritual piece, right? 00:27:51.337 --> 00:27:54.607 Because you were talking about the whole person and viewing the 00:27:54.607 --> 00:27:58.387 whole person in a way that takes into account their quality of life. 00:27:58.387 --> 00:28:03.737 So how do you help patients incorporate, let's say cultural 00:28:03.737 --> 00:28:06.827 beliefs or their spiritual concerns? 00:28:06.837 --> 00:28:11.017 Here in New York people of the Jewish faith even have a halachic living 00:28:11.017 --> 00:28:14.327 will which is governed by Judaic Law. 00:28:15.067 --> 00:28:19.477 How do you help patients incorporate those beliefs maybe that you're not 00:28:19.477 --> 00:28:21.757 familiar with, into their care plan? 00:28:22.762 --> 00:28:22.763 Dr. Matthew Tyler: 00:28:22.762 --> 00:28:24.682 Yeah, so I think a couple things on that front. 00:28:24.682 --> 00:28:29.187 As a as a physician, a specialty physician at that, I think the 00:28:29.337 --> 00:28:31.047 best place to start is by asking. 00:28:31.387 --> 00:28:36.422 I try to highlight and make a habit of asking, how are you spiritual, religious? 00:28:36.502 --> 00:28:38.452 Many people are and many people are not. 00:28:38.582 --> 00:28:41.692 But for folks who are, I'll ask you, how does that fit into 00:28:41.692 --> 00:28:42.832 your medical care right now? 00:28:42.832 --> 00:28:47.122 Is there anything that's important to know about how your spirituality or religious 00:28:47.122 --> 00:28:48.922 beliefs might impact your medical care? 00:28:49.372 --> 00:28:51.802 And that is typically where, folks who are Jehovah's Witness 00:28:51.802 --> 00:28:53.572 may, say no blood transfusions. 00:28:53.572 --> 00:28:57.712 And I think similar to your question, if there's anything important to know, 00:28:58.367 --> 00:29:01.287 I have to keep an open mind 'cause I don't know how they all work for people. 00:29:01.287 --> 00:29:06.042 But I make a point to ask and if there's ever, a particular decision we need to 00:29:06.042 --> 00:29:10.032 make, and I'm not sure how religious beliefs fit in and nor is the patient, 00:29:10.432 --> 00:29:13.732 we always encourage 'em to reach out to their community, religious leaders and 00:29:13.732 --> 00:29:15.802 get their input whenever possible too. 00:29:15.882 --> 00:29:18.162 'Cause we don't, the nice thing about my job is I don't 00:29:18.162 --> 00:29:19.692 have to know all the answers. 00:29:19.722 --> 00:29:22.407 And often I try to connect 'em with the folks who do. 00:29:22.652 --> 00:29:23.252 Candace Dellacona: Of course. 00:29:23.252 --> 00:29:26.682 And reminding them that they can do that, that those are, certainly 00:29:26.682 --> 00:29:28.227 great questions for them to ask. 00:29:28.397 --> 00:29:31.477 Turning the topic a little bit. 00:29:31.867 --> 00:29:35.347 There's been a lot of talk, especially at the beginning of the year of, 00:29:35.417 --> 00:29:40.397 healthcare coverage and the logistics related to Medicare and private 00:29:40.397 --> 00:29:42.857 insurance and how people pay for things. 00:29:42.857 --> 00:29:46.657 So is there something from a physician's perspective, that you'd like to 00:29:46.657 --> 00:29:50.317 share with the listeners about what families maybe should know about 00:29:50.317 --> 00:29:53.682 insurance coverage as it relates to their access with palliative care? 00:29:54.892 --> 00:29:54.893 Dr. Matthew Tyler: 00:29:54.892 --> 00:29:57.952 Unfortunately, like everything in healthcare that what your coverage 00:29:57.952 --> 00:30:00.592 looks like will depend on your plan. 00:30:00.682 --> 00:30:05.812 So you your big ones that are being your private insurances or a Medicare Advantage 00:30:05.812 --> 00:30:09.612 plan that's run by a private insurance or traditional Medicare, speaking 00:30:09.612 --> 00:30:11.482 to the 65 and over population here. 00:30:11.982 --> 00:30:15.792 So palliative care referrals are just like any other specialty referral. 00:30:15.842 --> 00:30:19.732 So, if you need a referral versus if you can self-refer, what's your copay 00:30:19.732 --> 00:30:23.602 gonna be and all that stuff will be as relevant as it is for anything else you're 00:30:23.602 --> 00:30:25.072 getting in your healthcare right now. 00:30:25.942 --> 00:30:28.862 Candace Dellacona: A referral, like a traditional referral as you'd think if you 00:30:28.862 --> 00:30:30.842 need a referral for an orthopedic doctor. 00:30:31.187 --> 00:30:31.188 Dr. Matthew Tyler: 00:30:31.187 --> 00:30:31.307 Yeah. 00:30:31.337 --> 00:30:34.942 For most people, yeah, you do have to get a physician referral. 00:30:35.242 --> 00:30:40.402 And there are a plan, I think PPO some PPO plans do allow you to self-refer. 00:30:40.792 --> 00:30:44.002 So If you have a self, it's always good to know how your insurance works 00:30:44.002 --> 00:30:46.342 in general to avoid nasty surprises. 00:30:46.712 --> 00:30:48.992 But I would always check to see if you can, if you have a plan 00:30:48.992 --> 00:30:50.252 that allows you to self-refer. 00:30:50.732 --> 00:30:53.432 If you do have a plan that requires physician referrals for palliative 00:30:53.432 --> 00:30:57.572 care, I was, I just had a, someone asked me about this the other day, but 00:30:57.572 --> 00:31:00.282 they they said, well, what if you're getting cancer treatment and you ask 00:31:00.282 --> 00:31:03.342 your oncologist for a palliative referral and they say, no, you don't need that. 00:31:03.342 --> 00:31:04.632 What do you need palliative care for? 00:31:04.692 --> 00:31:06.642 And, or what do you do? 00:31:06.742 --> 00:31:11.472 And in situations like that, you don't need that specific doctor's referral. 00:31:11.502 --> 00:31:15.252 You can go to your primary care doctor or your geriatrician and get 00:31:15.252 --> 00:31:17.262 a referral through them if you like. 00:31:17.572 --> 00:31:19.792 Or you can talk to the social worker or nurse and have them, 00:31:19.792 --> 00:31:21.472 apply a little like inside pressure. 00:31:21.552 --> 00:31:21.672 Candace Dellacona: Right. 00:31:22.497 --> 00:31:22.498 Dr. Matthew Tyler: 00:31:22.497 --> 00:31:25.557 it's often the nurses and the social workers and chaplains who understand 00:31:26.007 --> 00:31:29.037 the ins and outs of palliative care more so than the doctors and many 00:31:29.037 --> 00:31:32.907 times and can know how to like, say the thing to get the thing that you need 00:31:32.957 --> 00:31:35.537 Candace Dellacona: Right, the right words and phrase it the right way. 00:31:35.807 --> 00:31:35.808 Dr. Matthew Tyler: 00:31:35.807 --> 00:31:36.437 Yeah. 00:31:36.467 --> 00:31:39.287 Yeah, you know, there are a lot of avenues you can go that way. 00:31:39.737 --> 00:31:42.887 And, but while we're on the topic of insurance I do wanna call out 00:31:42.887 --> 00:31:46.837 that hospice works a lot differently when it comes to insurance coverage. 00:31:47.197 --> 00:31:49.987 And I think probably the main things you know about hospice care is it's all 00:31:49.987 --> 00:31:51.297 covered through traditional Medicare. 00:31:51.697 --> 00:31:54.517 So even if you have an advantage plan, if you're moving to hospice care, you get 00:31:54.517 --> 00:31:56.377 kicked back over to traditional Medicare. 00:31:56.907 --> 00:32:02.397 And in, in that case, your Medicare hospice benefit covers everything 00:32:02.667 --> 00:32:04.347 provided by the hospice agency. 00:32:04.347 --> 00:32:08.257 The nursing visits the social work visits, the medications, the equipment 00:32:08.257 --> 00:32:10.827 like the bed and the wheelchair, the oxygen, that's all covered by 00:32:10.827 --> 00:32:12.417 your Medicare hospice benefits. 00:32:13.212 --> 00:32:13.962 Candace Dellacona: Which is amazing. 00:32:13.962 --> 00:32:17.852 I think one of the things that leads to some confusion for my clients anyway, 00:32:17.852 --> 00:32:23.592 and I think just in the public at large is that when someone is, fits the 00:32:23.592 --> 00:32:27.552 category of hospice and they receive the hospice, I guess diagnosis, if 00:32:27.552 --> 00:32:31.732 that's the right terminology, there's also an assumption that they'll receive 00:32:32.482 --> 00:32:34.642 home care services through hospice. 00:32:34.642 --> 00:32:39.652 I think what's really important to distinguish for people is that the care 00:32:39.652 --> 00:32:44.062 that you receive is actually a nurse, which is considered skilled care to come 00:32:44.062 --> 00:32:49.772 in and check up on you, but that does not, hospice does not automatically cover 00:32:50.162 --> 00:32:56.762 the home care attendant role, which is the activities of daily living, which 00:32:56.852 --> 00:33:01.862 are often really needed with someone who's on home hospice but is not covered 00:33:02.042 --> 00:33:04.172 through home hospice and Medicare. 00:33:05.132 --> 00:33:05.133 Dr. Matthew Tyler: 00:33:05.132 --> 00:33:09.117 Yes, this is a major gap in the Medicare benefit in general. 00:33:09.117 --> 00:33:13.317 As you said it's most noticeable when it comes to hospice care. 00:33:13.397 --> 00:33:16.337 But as you're getting at, there's no scenario where Medicare will 00:33:16.337 --> 00:33:18.947 pay for private in-home caregivers. 00:33:18.997 --> 00:33:23.047 Which is a real shame as often that is the difference between being able 00:33:23.047 --> 00:33:26.557 to live the rest of your life in your own home or having to, to move to a 00:33:26.557 --> 00:33:30.757 nursing home and spend all your money and apply for Medicaid and have Medicaid 00:33:30.757 --> 00:33:32.107 pickup the bill from the nursing home. 00:33:32.147 --> 00:33:36.167 But that is a major gap that I am talking to families about on 00:33:36.167 --> 00:33:38.777 a almost daily basis these days. 00:33:39.047 --> 00:33:40.002 And you're right. 00:33:40.002 --> 00:33:40.842 It's an expectation. 00:33:40.842 --> 00:33:44.442 If you're sick enough to need hospice, then most people find themselves needing 00:33:44.442 --> 00:33:48.802 24 hour supervision and are shocked to learn that there's no mechanism through 00:33:48.802 --> 00:33:52.702 most major insurance plans, including Medicare, to get that sort of support. 00:33:53.347 --> 00:33:55.517 Candace Dellacona: And people in the sandwich generation are often those 00:33:55.567 --> 00:33:59.397 that are filling that gap and trying to pull that need, whether it's a 00:33:59.397 --> 00:34:03.167 daughter or in my case, I was a niece trying to coordinate all of that. 00:34:03.587 --> 00:34:07.007 So yeah, I mean it's really helpful to know that in advance and understand 00:34:07.007 --> 00:34:10.097 that there can even be a significant financial burden with that. 00:34:10.737 --> 00:34:14.187 You've been so generous with your time, Matt and I only have one more question 00:34:14.187 --> 00:34:15.747 and then I promise I will let you go. 00:34:16.677 --> 00:34:23.637 What do families often say to you, that they wish they had known sooner 00:34:23.787 --> 00:34:28.707 about palliative care and hospice and anything under your umbrella? 00:34:30.972 --> 00:34:30.973 Dr. Matthew Tyler: 00:34:30.972 --> 00:34:36.142 Most people ask why we haven't been involved sooner is really the big thing. 00:34:36.242 --> 00:34:40.832 One, one of the other common questions that families would ask is really 00:34:40.832 --> 00:34:43.022 just, what should I be asking? 00:34:43.122 --> 00:34:47.037 When you're thrown into this situation, you know, caring for a parent who's 00:34:47.037 --> 00:34:49.467 getting sicker, for most people, they're doing this for the first 00:34:49.467 --> 00:34:53.067 time and for most people, they're not medically trained and they have no 00:34:53.067 --> 00:34:54.957 idea what's normal and what's not. 00:34:55.007 --> 00:34:57.857 And especially in medicine where the whole thing's a dumpster fire, medicine 00:34:57.857 --> 00:35:03.037 doesn't function like a business or a law firm or these other operations 00:35:03.037 --> 00:35:05.227 that just make more logical sense. 00:35:05.227 --> 00:35:09.907 And there's an order to things that just, it's not the same in medicine and 00:35:09.907 --> 00:35:13.652 it's hard to reality check yourself if you're not familiar with the territory. 00:35:13.702 --> 00:35:16.922 For most people, once they meet us, they ask where have you been? 00:35:16.922 --> 00:35:18.632 Like, why weren't you involved sooner? 00:35:18.662 --> 00:35:23.032 And that's why I am on social media talking to people about palliative care. 00:35:23.032 --> 00:35:24.622 So they know to ask for us sooner. 00:35:24.652 --> 00:35:27.492 'Cause there's a good chance that they're gonna bring it up before their doc does. 00:35:28.592 --> 00:35:31.602 Candace Dellacona: I started this podcast because I wanted to provide resources as 00:35:31.602 --> 00:35:36.992 I said and you are the perfect example of someone who shares his knowledge 00:35:38.042 --> 00:35:43.202 to people that really need it and are searching for it, and you're helping 00:35:43.562 --> 00:35:47.762 people like me and the sandwich generation survive and thrive and figure it all out. 00:35:47.762 --> 00:35:52.052 So from the bottom of my heart, thank you so much for taking time 00:35:52.052 --> 00:35:55.932 away from your schedule today to share all of your knowledge with us. 00:35:56.522 --> 00:36:01.337 And we're gonna have all of your social media profiles in our show notes, so 00:36:01.337 --> 00:36:05.717 that our listeners can follow along and learn as much as I have from you. 00:36:05.957 --> 00:36:08.147 So thank you so much for being here today, Matt. 00:36:08.757 --> 00:36:08.758 Dr. Matthew Tyler: 00:36:08.757 --> 00:36:09.712 It was a pleasure to be here. 00:36:09.712 --> 00:36:10.642 Thank you for having me. 00:36:10.817 --> 00:36:11.892 Candace Dellacona: Yeah, my pleasure.