Palliative Care: Old fashioned medicine

“Palliative care is really old fashioned medicine. It’s the way Marcus Welby, M.D. practiced medicine on television in the 60s and 70s,” according to Dr. Annie Hargadon, Yolo Hospice’s new palliative care medical director. Annie recently joined the organization’s 80-member team to expand its palliative care program, YoloCare, and to deepen its knowledge and expertise in the field of palliative medicine.

“If you’re old enough to remember,” she says, “you’ll recall that Dr. Welby had a kind bedside manner and paid attention to the whole person, not just the person’s medical condition. He took time to listen to his patients so that he could align their care with their individual values.” Even though the public perceives palliative care as a relatively new field, Annie likens it to the way care was provided when doctors made home visits.

When asked to explain palliative care, she says it is important to understand that it is different than hospice and should be offered as soon as someone is diagnosed with a serious illness. “It’s a way to ensure that a patient is receiving the kind of care that reflects their values,” she explains. “It helps people live as long as possible and as well as possible. Too many folks equate palliative care with the idea of helping someone to die, but it’s actually the opposite of that. It is helping them to live.”

One story that Annie likes to recall has to do with an 89-year-old World War II veteran who was diagnosed with a rare form of lymphoma. He originally said he wanted to do everything possible to fight the disease. “There were several aggressive treatments and clinical trials available to him, but none of the options seemed compatible with his active family life and his short-term goals,” she says. “Later, after talking about the things that were important to him, he decided to forgo any of the treatment options. Instead, we helped him live well until the day he died. I’ll always remember that.”

Annie says her path to becoming a certified palliative medicine doctor has been a long journey. It started nearly 30 years ago when she was a student at Dartmouth Medical School. There was a patient who was in her 30s with stage four metastatic breast cancer. As she describes the patient, she says, “This was a woman who was high energy. She was a school teacher, an Olympic swimmer, tennis player and gregarious in so many ways. I think, because of that, we all got swept up in the momentum of more and more treatments and procedures. We all kept thinking, let’s keep going, but we never asked this woman what was important to her . . . even though we knew that adding days to her life was not realistic.”

At the time, bone marrow transplants were considered an amazing new treatment that could offer patients hope of remission. However, that wasn’t the case with this patient or many others. “I’m sure we shortened her life and diminished her quality of life,” says Annie.

That experience, along with many others, stuck with Annie during her nearly three-decade-long career as an internal medicine physician. So, in 2014 at the age of 53, she did something gutsy and rather unconventional. She went back to school to enroll in a palliative medicine fellowship at the UC-Davis School of Medicine.

Even though the fellowship is typically a one-year program, Annie requested that a second year be added so that she could focus on research. “The second year was a gift to myself and a great experience,” she says.

For the past year Annie has been working closely with an oncology fellow to review the prescribing habits of oncologists who provide anti-cancer medications for their patients. She says, “There are no guidelines for the oral anti-cancer medications and many have side effects that are quite miserable. We need to understand how we should, or should not, use them at end-of-life. It’s not clear what these drugs are doing for patients in their final months, weeks, or days.”

The other piece of research Annie has focused on has to do with models of concurrent care and the open access model of hospice. “If we have concurrent care we can ease patient decisions about entering hospice. My dream is for palliative medicine and hospice to weave together more seamlessly than they do today.” She recently penned an article related to this research that is under review for publication in the Journal of Palliative Medicine.

When talking about Yolo Hospice, Annie equates the organization with the age-old Indian parable of the blind men and the elephant. Each man touched the elephant to learn what is was like, and each felt a different part of the animal . . . the tusk, trunk, foot, tail, etc. At first they all disagreed what the creature looked like, but then realized that they were all correct. It was their collective experience and perspectives that provided the full picture of what an elephant looks like. “Our care team at Yolo Hospice does the same thing. Everyone comes together with their own experience and interaction with a patient and it’s that collective expertise that helps us provide whole-person care for each individual. The teamwork and comradery here is truly impressive.”

Dr. Annie Hargadon received her BA from Stanford and her Doctor of Medicine from Dartmouth Medical School. During her career, she has worked for the Winters Healthcare Foundation, Veterans Health Administration, and Santa Clara Valley Medical Center. She and her husband, and their 16-year-old daughter, live in Davis. Her husband is a professor at UC-Davis Graduate School of Management. Her only brother is a physician with the Centers for Disease Control in Atlanta.