Porter practice performing well

MIDDLEBURY — It’s been seven months since Middlebury doctors Diana Barnard and Will Porter saw the first patient in their new practice, Partners in Palliative and Home Care, and they say that it is going very well.
And Porter Medical Center board chairman Joe Sutton agreed — he introduced Barnard’s keynote speech at Porter’s annual meeting last Thursday with glowing praise.
“This is a practice that is unique within the state, and even the country,” said Sutton.
There is a growing need for palliative care not just locally, but also nationally, Barnard pointed out in her speech. She also spoke of the growing attempts to raise awareness of exactly what palliative care entails — that is, care with a focus on alleviation of pain and suffering for patients with advanced illnesses, as opposed to cure-oriented treatment.
With their presence in the community, Barnard and Porter are hoping to create this awareness. So far, Barnard said, it is working — by the second month, the practice was consistently meeting its revenue targets. The two doctors have been kept busy taking care of a total of 103 patients since Sept. 1, and are hoping to get an electronic medical record system up and running in the coming months.
“We’re finding ourselves very useful,” she said. “Nobody (in the county) has set up a practice like this.”
The unique nature of Barnard and Porter’s work lies not only in the small number of palliative care practices in the country, but also because of their approach. The practice’s home care structure, designed especially for patients who have difficulty leaving their homes, allows the doctors to work with only minimal office space.
“The practice has low overhead — instead, it is time-intensive,” said Barnard.
Barnard explained how she and Porter, both formerly of Middlebury Family Health, had come to launch the practice last fall. Through experiences both with patients and with those close to them, each doctor one came to appreciate the need for a focus on more holistic end-of-life care.
Part of this, said Barnard, is the importance of talking about end-of-life plans before there is a pressing need, in order to make death as comfortable and peaceful an experience as possible. While 55 percent of deaths in the United States occur in hospitals and 22 percent occur in nursing homes, she said, most people say that they would choose to die in their own home or in the home of a loved one.
By thinking not only toward a cure but also toward what will allow the patients to live out their life in the fullest, most pain-free way, Barnard and Porter say they have also saved their patients — and Medicare — money by fully evaluating available choices before recommending tests or procedures.
The best way to do this, the doctors say, is by really listening to their needs — a process made much easier by the setting of their meetings, not in a sterile doctor’s office but in the patient’s home.
“You’re not in an office, and you’re not in a hurry — it’s easier to talk about sensitive topics,” said Porter.
The pace and setting of the appointments allows the doctors to communicate more fully with patients and their families.
“The essential thing is that people get good end-of-life care through knowledge of the choices available to them,” he said.
Brookes Cowan, a University of Vermont medical sociologist and gerontologist, will be giving the keynote speech in part on the importance of palliative care at the Hospice Volunteer Services of Addison County’s annual meeting next Wednesday, April 7. To her, the significant strides that palliative care is making in recent years is a very good — and necessary — thing.
“The Baby Boomers are becoming senior boomers,” she said.
According to Cowan, the population of the United States that is 65 years of age and older is expected to reach about 25 percent of the country’s total population.
As the population ages, people not only live longer, they also tend to live out serious trauma conditions and progress to more advanced illnesses.
Though this is the case, many seniors still die in hospitals, undergoing treatments with very small percentages of success.
“Physicians are trained to see death as failure,” said Cowan.
And while this is not necessarily a bad thing, last-ditch attempts to prolong life are often more painful than they are effective.
“If you can control the symptoms of physical suffering, the patient will live more fully,” said Cowan.
This is one of the goals of hospice care, which is dedicated to providing holistic care to those with very little time to live. And while studies show that those in hospice live longer than others with similar prognoses, the lingering association of hospice care with “giving up” is a barrier to many.
“Hospice in this country is greatly underutilized,” she said. “The median range of stay in hospice is about 21 days.”
Part of this problem, said Cowan, is the current structure of the country’s health care system. Though Medicare covers hospice care, it requires that a person must agree to discontinue all cure-oriented treatments, and it requires that a doctor estimate that the patient has less than six months to live.
In this spectrum, palliative care can provide a necessary bridge for ailing patients who do not yet qualify for hospice care — a way to aid patients and their families — not only medically, but also psychologically and spiritually.
In recent months, palliative care specialists have been closely following federal health care reform discussions. The Independence at Home Act would have created medical teams to provide home care under the purview of Medicaid, echoing the structure and purpose of Porter and Barnard’s practice. And while that act did not make it into the final health care reform law, according to Barnard the new laws do include the beginning structure on which to build this type of care system.
And as the country moves toward further reform to aid its struggling health care systems, Cowan hopes to see some of the tenets of palliative care extent beyond care for chronically ill patients.
“I see many benefits of using palliative care as a model for remodeling the health care system,” she said. “Patients are treated in a humanistic fashion.”
In that respect, she said, care becomes not only focused on intervention, but also on prevention and palliation.
“We want not just a medical system, but a health care system,” said Cowan. “One that looks at the whole person.
Brookes Cowan will speak at the Hospice Volunteer Services annual meeting on Wednesday, April 7. The meeting will run from 6:30 to 8:30 p.m. at Counseling Service of Addison County on Exchange Street in Middlebury.
Reporter Andrea Suozzo is at [email protected].

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