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Medical Specialty Clinic

Dr. Clyde Smith, an oncologist/hematologist is a founder of Medical Specialty Clinic, a multi-specialty clinic that also has specialists in dermatology and gastroenterology. The clinic is at 27 Medical Center Drive in Jackson.
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Dr. Clyde Smith, center, discusses a patient’s care with Pat Bard, above left, Social Service Coordinator; and, above right, nurse Carrie Knox, RN, CHPN; and Chaplain James Watford

Team provides options for severe chronic illness

Dr. Clyde Smith has seen it happen many times in his career as a physician: A patient is in the hospital with a serious chronic illness. Aggressive measures to keep the patient alive are not changing the course of the illness. Instead they are simply prolonging the inevitable complication that probably will lead to the patient’s death.

“This aggressive medicine is not improving the patient’s quality of life,” says Dr. Smith. In fact, he considers it inappropriate to put a patient through tests and procedures that will not change the outcome of the disease.

His work with Hospice, which provides in-home support for the family and the terminally ill patient, has led him to help create a palliative care team at Jackson-Madison County General Hospital for patients in the hospital with severe chronic illness.

Like Hospice, the palliative care team consists of physicians, nurses, social workers and chaplains who work with the patient and his family to meet physical, psychological, social and spiritual needs. Goals are set and decisions are made about life support.

Whereas Hospice evolved in the early 1980s for care of the terminally ill at home; the idea of palliative care has evolved over the last five to 10 years as an in-patient hospital service, says Dr. Smith, who specializes in treating cancer and blood diseases and is board certified in palliative care-hospice.

“Palliative care is a discipline of medicine that deals with the total care of the patient and the family,” says Dr. Smith. “It’s better, more humane care. We don’t put people through procedures, x-rays or extra medicines that aren’t going to make a difference.”

Jackson General’s Palliative Care Consulting Team, which includes Dr. Smith, was formed in early 2009.

“Medicine does a good job managing chronic illnesses to a certain point,” he explained. But, when chronic illness reaches that point when we can’t alter the clinical course of the illness, we don’t do as good a job. We tend to do the same procedures as we would if we could cure the illness. We have a hard time when a patient starts that downhill slope — at that point, that’s when palliative care and even hospice is the best and the most humane care.”

His gives an example of an 83-year-old woman who lives in a nursing home and who has had severe Alzheimer’s for seven years. Nurses notice that she is not as responsive as usual. They call the doctor, who tells them to take her to the emergency room. There, doctors find her kidney function is poor, she is dehydrated and has bacteria in her urine. She stays in the hospital for seven days on IV fluids and antibiotics and is sent back to the nursing home once her body chemistries improve. Three months later, the same thing happens again.

“What are we doing to people?” Dr. Smith asks. “We have not improved this lady’s quality of life. Medicine can keep bodies alive a lot longer than we can keep people alive. We didn’t get her better; she still has severe dementia. She’s just alive so she can go through this again.”

The hospital’s new palliative care team would discuss options for her care with the woman’s family, Dr. Smith explains. The team would talk about continuing the same course of treatment as before or taking another course, which would focus on comfort measures, improving the patient’s quality of life and allowing a natural death.

With palliative care, managing the patient’s physical symptoms includes pain management and treating nausea, vomiting, restlessness, anxiety, confusion, shortness of breath and other symptoms.

“A politician once said that America is the only society that believes death is an option,” Dr. Smith adds. “Society expects the medical profession to be able to make people well. But death isn’t an option. It’s inevitable.”

In America, he explained, people can die from acaccidents, suicide, violence or an infectious disease. “But, if we live long enough, we are all going to get a chronic disease — whether that be heart, liver or kidney disease; stroke or cancer; Parkinson’s or another form of dementia — and we will eventually die from a complication of that chronic disease.”

Palliative care is a new concept for many families, who often feel they must grasp for hope and do anything possible to keep a loved one alive. “Each family and each individual has to go through this in their own way and at their own pace,” Dr. Smith says.

“Society will have to change the way it views death,” he adds. “Medicine will have to quit doing things that won’t help. And families will have to learn how to let go.” Meanwhile, for those families struggling to make the right decision, Jackson General’s palliative care team is there to provide support.

For more information about the Palliative Care Consulting Team at Jackson-Madison County General Hospital call 731-664-2200.