Session 104 Dr. Bruce Chamberlain tells me why he sees palliative medicine as more of a calling than a specialty. We discuss empathy, communication, and avoiding burnout. Bruce has been out of his training now for 29 years and has been practicing hospice and palliative care medicine all around the country. In case you may not have come across it yet, please do check out Board Rounds podcast, which I do with BoardVitals, a USMLE/COMLEX Step 1/Level1 test prep company. They offer QBanks for both Step 1 and Level 1. They also have amazing QBanks for your SHELF exams for your clinical years. Going back to the episode today, palliative and hospice medicine is a specialty that is important. But not a lot of people know about this and not a lot of people actually consult palliative medicine early enough. Listen to this podcast episode with the player above, or keep reading for the highlights and takeaway points. [01:50] Interested in Palliative and Hospice Care Bruce got into this specialty without a plan, in fact, he had never heard of it before. He was board-certified in internal medicine and practicing in a clinic doing internal medicine. Seeing that the majority of his patients were elderly, he began to notice a trend in his patients. They often had a functional limitation as a result of pain, whether they had osteoarthritis or low back pain. Bruce started self-educating in noninvasive pain management as well as some low-level injections. He partnered with a physical therapist. They started to become more aggressive with pain management and saw great success. As a result, a fair part of his clinic was devoted to geriatric pain management. Through the course of time, one of his patients ended up in the hospice. The hospice called him and asked to help them with pain management. So during his day off, he'd work at the hospice. Bruce considers working in hospice or palliative care as more of a calling than a job. You just feel like this is where you belong and what you're supposed to be doing.  And this happened to him. He began looking forward to half-day of the week going to the hospice. It was when he felt it was being the kind of doctor that he wanted to be. Because of this, he slowly increased his hospice time and decreased his clinic time. Until finally, the clinic asked for his commitment and asked him to fish or cut bait. While at that time, the hospice offered him a full-time position so he cut bait. From then on, he never looked back. He has done hospice and palliative care full-time or part-time for over 20 years now. [Related episode: Palliative Care - There is Always Something You Can Provide] [05:20] On Being Around Death All The Time Bruce explains that in hospice, you have to change your mindset in that you have to accept the reality that people die. Physicians are trained in the combat mode, fighting disease. And they are taking it as a personal and professional failure when a patient dies even though that's going to happen to all of us. When you accept the reality of death, then success becomes – was the patient comfortable? Were they able to have closure on outstanding emotional issues? Was the family able to be there? Were they able to die at home as opposed to being plugged into 15 different tubes and monitors in the ICU? Yes, it's sad that they died. But it's great that they died in a way they wanted to and they were comfortable.  Moreover, usually at the very end of hospice care, there would be months before death takes places where you just manage their symptoms. It's about improving their quality of life for the time they have left because they were able to aggressively manage their symptoms. And oftentimes, they get positive feedback before the death as well as after the death with family comes up to thank them. [Related episode: This Physician Wants to Change The Narrative Around Death] [08:35] Traits that Make a Great Hospice and Palliative Care Physician You have to be patient and have empathy. But you