1 00:00:00,667 --> 00:00:03,917 (upbeat ambient music) 2 00:00:11,890 --> 00:00:13,480 - Welcome to Health Source. 3 00:00:13,480 --> 00:00:15,340 A community education program 4 00:00:15,340 --> 00:00:18,670 brought to you by the University of Vermont Health Network, 5 00:00:18,670 --> 00:00:21,170 which includes the UVM Medical Center, 6 00:00:21,170 --> 00:00:23,260 Central Vermont Medical Center, 7 00:00:23,260 --> 00:00:25,450 Champlain Valley Physicians Hospital, 8 00:00:25,450 --> 00:00:27,800 Elizabeth Town Community Hospital, 9 00:00:27,800 --> 00:00:30,360 and Alice Hyde Medical Center. 10 00:00:30,360 --> 00:00:33,240 Your host today is Alexandra Tursi 11 00:00:33,240 --> 00:00:35,303 from the UVM Medical Center. 12 00:00:36,190 --> 00:00:37,830 - Death is a reality of life, 13 00:00:37,830 --> 00:00:39,830 but it's hard for us to talk about. 14 00:00:39,830 --> 00:00:42,100 The medical community wants to change that. 15 00:00:42,100 --> 00:00:45,170 As our elderly and chronically ill population expands, 16 00:00:45,170 --> 00:00:47,250 medical professionals are looking at new ways 17 00:00:47,250 --> 00:00:49,230 to approach the experience of death 18 00:00:49,230 --> 00:00:52,500 by changing how we talk about it and how we plan for it. 19 00:00:52,500 --> 00:00:55,010 This work is centered in the field of palliative care 20 00:00:55,010 --> 00:00:57,890 which aims to ease a suffering of patients and families 21 00:00:57,890 --> 00:00:59,800 facing serious or terminal illness 22 00:00:59,800 --> 00:01:02,460 with a focus on quality of life. 23 00:01:02,460 --> 00:01:04,470 Here today to talk to us about palliative care 24 00:01:04,470 --> 00:01:07,390 is Dr. Robert Gramling, the Holly and Bob Miller Chair 25 00:01:07,390 --> 00:01:08,880 in Palliative Medicine 26 00:01:08,880 --> 00:01:10,730 at the University of Vermont Medical Center 27 00:01:10,730 --> 00:01:12,840 and the UVM College of Medicine. 28 00:01:12,840 --> 00:01:14,980 Dr. Gramling is a nationally respected leader 29 00:01:14,980 --> 00:01:17,730 in palliative and hospice care and will be responsible 30 00:01:17,730 --> 00:01:19,850 for building the palliative medicine program 31 00:01:19,850 --> 00:01:22,670 at the UVM Medical Center and College of Medicine. 32 00:01:22,670 --> 00:01:24,030 Welcome to the program, Bob. 33 00:01:24,030 --> 00:01:25,660 - Thanks Alexandra, thanks for having me. 34 00:01:25,660 --> 00:01:27,920 - So I'm just gonna jump in with a big question. 35 00:01:27,920 --> 00:01:29,490 - Please do. - Why are we afraid 36 00:01:29,490 --> 00:01:31,030 to talk about death? 37 00:01:31,030 --> 00:01:33,310 - Yeah, you do jump in, that's fantastic, yeah, great. 38 00:01:33,310 --> 00:01:35,380 So the short answer is probably 39 00:01:35,380 --> 00:01:36,930 that it's one of the things we share 40 00:01:36,930 --> 00:01:39,300 that no one's experienced yet. 41 00:01:39,300 --> 00:01:43,430 And humans tend to fear the unknown, 42 00:01:43,430 --> 00:01:45,390 or at least wonder about it 43 00:01:45,390 --> 00:01:47,810 but probably the reasons we don't talk about death 44 00:01:47,810 --> 00:01:51,240 maybe as complex as any other human behavior, 45 00:01:51,240 --> 00:01:54,640 some is because it's maybe not normative in whatever society 46 00:01:54,640 --> 00:01:56,933 or community we happen to be living in. 47 00:01:57,800 --> 00:01:59,340 But I do think a substantial piece 48 00:01:59,340 --> 00:02:01,470 of this is it's just, it's really unknown. 49 00:02:01,470 --> 00:02:03,320 - And in your experience working with patients, 50 00:02:03,320 --> 00:02:06,260 what do you find matters to them 51 00:02:06,260 --> 00:02:09,370 when they're facing death or a serious illness? 52 00:02:09,370 --> 00:02:12,850 - Probably the most humbling piece of my job. 53 00:02:12,850 --> 00:02:14,980 Well, there's probably many humbling pieces of my job, 54 00:02:14,980 --> 00:02:18,750 but one of them is whenever I have a suspicion 55 00:02:18,750 --> 00:02:21,010 of what I think matters to somebody, 56 00:02:21,010 --> 00:02:23,320 I'm inevitably wrong until I ask them. 57 00:02:23,320 --> 00:02:27,410 So it's somewhat superficial to say it depends 58 00:02:27,410 --> 00:02:30,620 and it matters and it differs by who the person is, 59 00:02:30,620 --> 00:02:35,620 but in reality, that's kind of what I find is some people, 60 00:02:35,640 --> 00:02:40,580 what matters to them is what is gonna happen 61 00:02:40,580 --> 00:02:43,080 after their body has died, 62 00:02:43,080 --> 00:02:45,809 either with regards to how they're remembered 63 00:02:45,809 --> 00:02:49,690 or what happens existentially. 64 00:02:49,690 --> 00:02:52,530 Some worry a lot about the dying process, 65 00:02:52,530 --> 00:02:53,640 is this gonna hurt? 66 00:02:53,640 --> 00:02:55,370 Is it gonna hurt me? 67 00:02:55,370 --> 00:02:56,203 Is it gonna hurt my loved ones? 68 00:02:56,203 --> 00:02:58,850 And some aren't necessarily sure what's bothering them 69 00:02:58,850 --> 00:03:00,930 but just the idea of all of things are happening 70 00:03:00,930 --> 00:03:02,150 can be confusing and scary, 71 00:03:02,150 --> 00:03:05,530 so those are probably the spectrum of things. 72 00:03:05,530 --> 00:03:07,500 But to get to your point, I think a little bit what matters 73 00:03:07,500 --> 00:03:09,180 and I think almost no matter 74 00:03:09,180 --> 00:03:12,690 what specific thing about dying may be important 75 00:03:12,690 --> 00:03:14,540 to any individual person, 76 00:03:14,540 --> 00:03:16,610 I have found almost without exception 77 00:03:16,610 --> 00:03:20,940 that every person who encountered who is ill 78 00:03:20,940 --> 00:03:22,540 and who is potentially suffering 79 00:03:23,394 --> 00:03:24,300 and who is facing death 80 00:03:24,300 --> 00:03:27,743 wish to be understood and heard by those around them. 81 00:03:29,018 --> 00:03:29,851 And that may sound like a small thing, 82 00:03:29,851 --> 00:03:31,690 but it's a pretty big thing. 83 00:03:31,690 --> 00:03:33,820 - So how do you then make that happen? 84 00:03:33,820 --> 00:03:35,800 How do you work with patients 85 00:03:35,800 --> 00:03:39,400 and how do you create that environment of open communication 86 00:03:39,400 --> 00:03:42,151 about wants and needs and fears? 87 00:03:42,151 --> 00:03:46,290 - I think patients and families create it for me. 88 00:03:46,290 --> 00:03:48,830 I just have to give it some space. 89 00:03:48,830 --> 00:03:51,190 Oftentimes when you're meeting a new person 90 00:03:51,190 --> 00:03:52,560 and especially when patients are vulnerable 91 00:03:52,560 --> 00:03:55,680 if you're in a hospital, it can be a sometimes 92 00:03:55,680 --> 00:03:58,860 undignifying experience and we'll worry, 93 00:03:58,860 --> 00:03:59,750 you know, what's my agenda? 94 00:03:59,750 --> 00:04:00,870 Who is this guy? 95 00:04:00,870 --> 00:04:03,208 You know, he came in, he's from palliative care, 96 00:04:03,208 --> 00:04:04,424 I don't know what that means. 97 00:04:04,424 --> 00:04:05,870 So part of the first time is a meeting people, 98 00:04:05,870 --> 00:04:08,782 unless they've asked to see me and have a preconception. 99 00:04:08,782 --> 00:04:11,890 They might be wanting to just determine, am I a safe person? 100 00:04:11,890 --> 00:04:15,770 And trying to understand what my role is and why am I here. 101 00:04:15,770 --> 00:04:19,270 And once that barriers somewhat breached 102 00:04:19,270 --> 00:04:22,700 and get a sense that I am really here to understand 103 00:04:22,700 --> 00:04:25,200 who you are, what's going on and how I might be of help 104 00:04:25,200 --> 00:04:27,960 with what I understand to be happening 105 00:04:27,960 --> 00:04:30,410 that they tend to create the space that we go to 106 00:04:30,410 --> 00:04:32,200 about what's important to them. 107 00:04:32,200 --> 00:04:36,640 - And in your experience over the many years in your career, 108 00:04:36,640 --> 00:04:38,900 what kind of lessons have you derived 109 00:04:38,900 --> 00:04:42,480 from those conversations and work with patients? 110 00:04:42,480 --> 00:04:43,940 - I think a few things. 111 00:04:43,940 --> 00:04:47,420 One is I think as I mentioned before, 112 00:04:47,420 --> 00:04:49,170 and I'll come back to it again, 113 00:04:49,170 --> 00:04:52,890 every time I think I come in with some expectation 114 00:04:52,890 --> 00:04:55,260 of what I think is gonna matter to you or to me 115 00:04:55,260 --> 00:05:00,260 or to somebody else, I'm frequently odd and surprised, 116 00:05:00,760 --> 00:05:05,060 and interested to hear that what matters 117 00:05:05,060 --> 00:05:07,460 to people may not be what I was thinking. 118 00:05:07,460 --> 00:05:12,460 And so if I've learned anything, it's that I gotta ask. 119 00:05:13,440 --> 00:05:14,340 - Could you give an example 120 00:05:14,340 --> 00:05:18,490 of something that has been surprising or some stories? 121 00:05:18,490 --> 00:05:21,440 - So a relatively, this may not be common 122 00:05:21,440 --> 00:05:23,480 but something that we might experience 123 00:05:23,480 --> 00:05:26,930 with some frequency is when people are suffering 124 00:05:26,930 --> 00:05:31,370 with the idea of dying or with the symptoms of being ill 125 00:05:31,370 --> 00:05:33,530 and in a time period where they're not sure 126 00:05:33,530 --> 00:05:35,480 how long they're gonna live, 127 00:05:35,480 --> 00:05:38,640 when we ask, when someone may say I'm afraid of dying 128 00:05:38,640 --> 00:05:41,100 or that when we may get there in our conversation 129 00:05:41,100 --> 00:05:46,100 and when you ask or explore what is most scary to you, 130 00:05:47,870 --> 00:05:50,320 is it the idea of not being alive and what happens 131 00:05:50,320 --> 00:05:51,153 or are you worried 132 00:05:51,153 --> 00:05:52,780 that we're not gonna be able to care for you well 133 00:05:52,780 --> 00:05:54,950 when you're dying. 134 00:05:54,950 --> 00:05:58,520 And I find the majority of people 135 00:05:58,520 --> 00:06:01,240 that I've had these conversations with, 136 00:06:01,240 --> 00:06:03,300 it's the latter, it's the fact 137 00:06:03,300 --> 00:06:05,750 that they haven't had a chance to talk with someone about 138 00:06:05,750 --> 00:06:09,430 what's gonna happen when things stop working. 139 00:06:09,430 --> 00:06:13,330 I mean, most people have experienced some degree of pain 140 00:06:13,330 --> 00:06:16,180 or suffering in some way when their bodies stopped working 141 00:06:16,180 --> 00:06:19,250 and it can be, oh my goodness, are the doctors 142 00:06:19,250 --> 00:06:21,020 and nurses gonna be able to help me with this 143 00:06:21,020 --> 00:06:24,600 or are my last moments here are gonna be painful? 144 00:06:24,600 --> 00:06:27,470 And oftentimes that's one of the easier things to address 145 00:06:27,470 --> 00:06:30,010 is that, yes, we can do this well for you. 146 00:06:30,010 --> 00:06:31,180 It's gonna take some preparation, 147 00:06:31,180 --> 00:06:32,850 we're gonna have to talk about it 148 00:06:32,850 --> 00:06:34,450 or you're gonna have to tell me who your person is, 149 00:06:34,450 --> 00:06:36,810 so we can talk about it and have your back together 150 00:06:36,810 --> 00:06:38,870 but yes, we can do this well. 151 00:06:38,870 --> 00:06:40,060 - You're listening to Health Source 152 00:06:40,060 --> 00:06:42,420 from the University of Vermont Health Network. 153 00:06:42,420 --> 00:06:43,460 I'm Alexandra Tursi 154 00:06:43,460 --> 00:06:45,080 and we're talking about palliative care 155 00:06:45,080 --> 00:06:46,620 with Dr. Bob Gramling, 156 00:06:46,620 --> 00:06:48,830 the newly installed Holly and Bob Miller Chair 157 00:06:48,830 --> 00:06:50,450 in Palliative Medicine 158 00:06:50,450 --> 00:06:52,340 at the university of Vermont Medical Center 159 00:06:52,340 --> 00:06:54,190 and the College of Medicine. 160 00:06:54,190 --> 00:06:56,810 How would you define palliative medicine? 161 00:06:56,810 --> 00:07:00,470 - This is a definition that people worked hard on for 162 00:07:00,470 --> 00:07:03,170 Medicare to help define what palliative care is. 163 00:07:03,170 --> 00:07:04,860 And as I often remark, 164 00:07:04,860 --> 00:07:08,050 I don't necessarily turn to Medicare rules for poetry 165 00:07:08,050 --> 00:07:10,965 but I think this is a really wonderful definition 166 00:07:10,965 --> 00:07:12,381 that captures the pieces of this. 167 00:07:12,381 --> 00:07:14,690 So palliative care means patient 168 00:07:14,690 --> 00:07:16,950 and family centered care that optimizes 169 00:07:16,950 --> 00:07:19,120 quality of life by anticipating, 170 00:07:19,120 --> 00:07:21,330 preventing and treating suffering. 171 00:07:21,330 --> 00:07:23,300 Palliative care throughout the continuum of illness 172 00:07:23,300 --> 00:07:25,430 involves addressing physical, intellectual, 173 00:07:25,430 --> 00:07:27,430 emotional, social, and spiritual needs 174 00:07:27,430 --> 00:07:29,940 and to facilitate patient autonomy, 175 00:07:29,940 --> 00:07:32,570 access to information and choice. 176 00:07:32,570 --> 00:07:35,770 One of the reasons why I think that's a useful definition 177 00:07:35,770 --> 00:07:37,820 is that it helps address the fact 178 00:07:37,820 --> 00:07:39,770 that what we're talking about here is suffering. 179 00:07:39,770 --> 00:07:44,060 And that concept of suffering is different than disease. 180 00:07:44,060 --> 00:07:46,010 Disease is something that happens to ourselves 181 00:07:46,010 --> 00:07:47,810 and to our tissues and to our bodies 182 00:07:47,810 --> 00:07:50,350 and sufferings, it happens to persons. 183 00:07:50,350 --> 00:07:53,580 It's how that experience of disease 184 00:07:53,580 --> 00:07:56,020 or illness influences our identity, 185 00:07:56,020 --> 00:07:58,310 who we are, our intactness as a person, 186 00:07:58,310 --> 00:07:59,760 and it's a definition that Eric Sal 187 00:07:59,760 --> 00:08:01,970 uses in some of his writings. 188 00:08:01,970 --> 00:08:04,830 And so for us to do our job well, 189 00:08:04,830 --> 00:08:07,410 we need to understand who that person is 190 00:08:07,410 --> 00:08:10,430 because when we diagnose and treat suffering 191 00:08:10,430 --> 00:08:14,240 and anticipate it, I need to bring with me my understanding 192 00:08:14,240 --> 00:08:18,460 of the medical treatments of the pathophysiology 193 00:08:18,460 --> 00:08:21,010 and the things that the person body's experiencing, 194 00:08:21,010 --> 00:08:23,320 but I really have to have a really good understanding 195 00:08:23,320 --> 00:08:24,200 of who they are 196 00:08:24,200 --> 00:08:26,010 and how those experiences might influence 197 00:08:26,010 --> 00:08:28,090 their definition of self and personhood 198 00:08:28,090 --> 00:08:30,369 and how they are in the world. 199 00:08:30,369 --> 00:08:31,740 And so that's one reason I think this definition 200 00:08:31,740 --> 00:08:33,520 is quite eloquent. 201 00:08:33,520 --> 00:08:35,030 - And in thinking about that definition 202 00:08:35,030 --> 00:08:36,730 and some of what you just said 203 00:08:36,730 --> 00:08:39,870 and conversations happening in the media 204 00:08:39,870 --> 00:08:42,207 and else were about the experience of dying 205 00:08:42,207 --> 00:08:45,170 and the patient experience, what do you see as elements 206 00:08:45,170 --> 00:08:48,730 that need to potentially be redesigned or rethought of, 207 00:08:48,730 --> 00:08:52,010 as we think about this part of the patient experience? 208 00:08:52,010 --> 00:08:54,690 - Well, I just had the good fortune 209 00:08:54,690 --> 00:08:56,520 of coming from the announcement 210 00:08:56,520 --> 00:08:58,850 of the groundbreaking for the new hospital. 211 00:08:58,850 --> 00:09:02,420 And I think they had presented in a wonderful example 212 00:09:02,420 --> 00:09:05,170 that in designing that physical building, 213 00:09:05,170 --> 00:09:08,100 involving patients and families, and thinking about that, 214 00:09:08,100 --> 00:09:08,980 what do you need? 215 00:09:08,980 --> 00:09:10,610 What would be a good fit? 216 00:09:10,610 --> 00:09:12,810 So the first answer is involving the people 217 00:09:12,810 --> 00:09:17,436 who are experiencing it, both us and patients and families 218 00:09:17,436 --> 00:09:21,210 but with respect specifically to the concepts of suffering, 219 00:09:21,210 --> 00:09:25,580 the more we can do that will help us know 220 00:09:25,580 --> 00:09:27,850 either when we walk into someone's room, 221 00:09:27,850 --> 00:09:29,440 when we open their medical record 222 00:09:29,440 --> 00:09:30,930 as the people caring for them, 223 00:09:30,930 --> 00:09:32,700 we know a little bit about who they are, 224 00:09:32,700 --> 00:09:35,320 not just their diseases and the treatments, 225 00:09:35,320 --> 00:09:37,240 that would be a wonderful piece. 226 00:09:37,240 --> 00:09:39,320 And Harvey Chochinov has done some work. 227 00:09:39,320 --> 00:09:41,810 He's a psychiatrist in the palliative physician 228 00:09:41,810 --> 00:09:43,840 on concepts of dignity therapy, 229 00:09:43,840 --> 00:09:46,120 which is essentially that, 230 00:09:46,120 --> 00:09:48,810 this is saying, I really want to know your story. 231 00:09:48,810 --> 00:09:51,400 I'm gonna help organize your story and put it in a, 232 00:09:51,400 --> 00:09:53,640 either piece of paper and the old style charts 233 00:09:53,640 --> 00:09:54,910 or in the medical record 234 00:09:54,910 --> 00:09:56,330 in a way that those caring for you 235 00:09:56,330 --> 00:09:58,270 will know how you define yourself, 236 00:09:58,270 --> 00:09:59,170 a little bit about yourself 237 00:09:59,170 --> 00:10:00,770 so it'll help them care for you. 238 00:10:01,720 --> 00:10:06,720 And that is one step that the idea of who I am as a patient 239 00:10:07,350 --> 00:10:10,410 is not lost within all of the really important stuff too, 240 00:10:10,410 --> 00:10:12,380 which need to be there 241 00:10:12,380 --> 00:10:14,370 about how to manage the diseases I have 242 00:10:14,370 --> 00:10:16,560 but to get that up there and keep that for run center 243 00:10:16,560 --> 00:10:18,897 would be a, for me, would be 244 00:10:18,897 --> 00:10:20,840 a wonderful way to continue reengineering what we do. 245 00:10:20,840 --> 00:10:22,340 - And one aspect of that 246 00:10:22,340 --> 00:10:24,740 I think would probably also be the cultural element. 247 00:10:24,740 --> 00:10:27,020 How has that kind of played out 248 00:10:27,020 --> 00:10:29,030 as something you've considered 249 00:10:29,030 --> 00:10:32,213 in terms of where a person comes from, family traditions, 250 00:10:32,213 --> 00:10:34,163 who they are culturally? 251 00:10:35,420 --> 00:10:38,160 - One of the beauty is about cultures, 252 00:10:38,160 --> 00:10:41,940 it gives us different forms of collective identity. 253 00:10:41,940 --> 00:10:44,780 And in coming back to what I said before though, 254 00:10:44,780 --> 00:10:47,520 is one of the traps we can get in 255 00:10:47,520 --> 00:10:49,530 is making assumptions about people, 256 00:10:49,530 --> 00:10:51,060 because we think we know the community 257 00:10:51,060 --> 00:10:54,490 or the identities or the cultures that they come from. 258 00:10:54,490 --> 00:10:57,590 So I will want to ask them and explore, 259 00:10:57,590 --> 00:11:00,840 what is it that you bring to this situation you're in 260 00:11:00,840 --> 00:11:02,500 that is important for me to know to care for you? 261 00:11:02,500 --> 00:11:05,640 Are there things about your culture or your background 262 00:11:05,640 --> 00:11:07,150 that I need to know as your doctor 263 00:11:07,150 --> 00:11:09,590 to do a good job caring for you? 264 00:11:09,590 --> 00:11:10,750 Now, some people will look at me like, 265 00:11:10,750 --> 00:11:12,070 what are you talking about? 266 00:11:12,070 --> 00:11:14,871 But most won't, most will say, yeah, no, 267 00:11:14,871 --> 00:11:17,550 it's important to me that you refer to me this way, 268 00:11:17,550 --> 00:11:19,377 or it's important to me 269 00:11:19,377 --> 00:11:21,810 that you really include my family in this conversation 270 00:11:21,810 --> 00:11:24,410 'cause they've always really been there for me 271 00:11:24,410 --> 00:11:25,960 and we make decisions together. 272 00:11:26,940 --> 00:11:29,370 And when people are suffering as well, 273 00:11:29,370 --> 00:11:31,910 there may be traditions of their culture 274 00:11:31,910 --> 00:11:34,870 that we might otherwise ascribe to our background upbringing 275 00:11:34,870 --> 00:11:35,870 that they're no longer feeling 276 00:11:35,870 --> 00:11:37,630 are very functional for them at the moment. 277 00:11:37,630 --> 00:11:39,970 So they may not choose to define themselves 278 00:11:39,970 --> 00:11:44,830 as still requiring those cultural norms in their care 279 00:11:44,830 --> 00:11:46,977 or in who they are at the time. 280 00:11:46,977 --> 00:11:48,697 So, does that answer your question? 281 00:11:48,697 --> 00:11:49,746 - It does. - Just get at it a little bit. 282 00:11:49,746 --> 00:11:52,730 - So it sounds like really open communication is key 283 00:11:52,730 --> 00:11:56,350 and kind of without bias or preconceived notions. 284 00:11:56,350 --> 00:11:59,800 - Yeah, there's a concept called beginner's mind 285 00:11:59,800 --> 00:12:03,610 that some of the teachers, (indistinct) Buddhist teaching 286 00:12:03,610 --> 00:12:07,800 but is the idea that as soon as we think we're an expert, 287 00:12:07,800 --> 00:12:10,420 we really kind of stopped learning on some level. 288 00:12:10,420 --> 00:12:12,270 So if we can get ourselves in a space 289 00:12:12,270 --> 00:12:14,320 that we've think of ourselves as beginners, 290 00:12:14,320 --> 00:12:18,120 then we have the opportunity to be curious about one another 291 00:12:18,120 --> 00:12:19,300 and about who this person is. 292 00:12:19,300 --> 00:12:22,934 So I think that's something that we can aspire to is to 293 00:12:22,934 --> 00:12:25,950 not assume we're experts about who you are. 294 00:12:25,950 --> 00:12:29,130 - Your position is endowed by the Vermont philanthropist, 295 00:12:29,130 --> 00:12:30,500 Holly and Bob Miller. 296 00:12:30,500 --> 00:12:32,840 I'm just wondering how you've maybe connected 297 00:12:32,840 --> 00:12:35,260 with the Millers about palliative medicine 298 00:12:35,260 --> 00:12:39,090 and its role at the medical center in Vermont generally. 299 00:12:39,090 --> 00:12:43,340 - So I met Holly about a year ago almost 300 00:12:44,276 --> 00:12:47,420 and was immediately just aware of her energy and her spirit 301 00:12:47,420 --> 00:12:50,720 and deep dedication to this field of palliative care. 302 00:12:50,720 --> 00:12:53,470 And Bob more recently and felt the same thing from him. 303 00:12:53,470 --> 00:12:55,990 And what I've really been struck by, 304 00:12:55,990 --> 00:12:58,720 although this certainly this endowed chair 305 00:12:58,720 --> 00:13:02,720 provides an immense opportunity to innovate, 306 00:13:02,720 --> 00:13:04,770 to re-engineer the things that we were just talking about, 307 00:13:04,770 --> 00:13:07,280 to figure out how do we do this better. 308 00:13:07,280 --> 00:13:09,130 It really is in some ways 309 00:13:09,130 --> 00:13:14,130 a capstone to a life of dedication to this field. 310 00:13:14,701 --> 00:13:17,108 - So what do you hope to accomplish in your role here 311 00:13:17,108 --> 00:13:18,780 at the UVM Medical Center and the College of Medicine? 312 00:13:18,780 --> 00:13:20,130 - Well, and super broad strokes, 313 00:13:20,130 --> 00:13:22,630 so we'll say, you know gosh, wouldn't it be great 314 00:13:22,630 --> 00:13:26,750 if we could say that every person we see 315 00:13:26,750 --> 00:13:28,210 says that they feel heard 316 00:13:28,210 --> 00:13:30,460 and understood by those caring for them? 317 00:13:30,460 --> 00:13:34,240 That thing alone would be fantastic. 318 00:13:34,240 --> 00:13:37,610 And so when we think about trying to understand 319 00:13:37,610 --> 00:13:40,900 what does it mean to communicate well, the science of that, 320 00:13:40,900 --> 00:13:43,760 we've got fantastic opportunities in palliative care science 321 00:13:43,760 --> 00:13:45,960 to start understanding what does it mean to communicate well 322 00:13:45,960 --> 00:13:50,650 and how do we create our systems of care, 323 00:13:50,650 --> 00:13:54,810 the physical structural stuff, our training of ourselves 324 00:13:54,810 --> 00:13:56,440 and of our learning colleagues 325 00:13:57,320 --> 00:14:00,480 and the incentives that drive how we work 326 00:14:00,480 --> 00:14:05,240 and how we grow towards that goal of communicating well. 327 00:14:05,240 --> 00:14:08,350 And this is an incredibly exciting time 328 00:14:08,350 --> 00:14:12,620 to be engaged in that conversation and here at UVM, 329 00:14:12,620 --> 00:14:15,720 I think we're just, we're really poised to lead the nation, 330 00:14:15,720 --> 00:14:16,760 hearing this out 331 00:14:16,760 --> 00:14:17,750 - All sounds wonderful. 332 00:14:17,750 --> 00:14:20,500 And we're so excited to have you here at the medical center 333 00:14:20,500 --> 00:14:23,010 and to see what you will accomplish here. 334 00:14:23,010 --> 00:14:25,940 Our guest today on Health Source has been Dr. Bob Gramling, 335 00:14:25,940 --> 00:14:28,010 the newly installed Holly and Bob Miller Chair 336 00:14:28,010 --> 00:14:29,120 in Palliative Medicine 337 00:14:29,120 --> 00:14:31,070 at the University of Vermont Medical Center 338 00:14:31,070 --> 00:14:32,450 and the College of Medicine. 339 00:14:32,450 --> 00:14:34,097 Thank you for joining us today, Bob. 340 00:14:34,097 --> 00:14:35,434 (upbeat ambient music) - Thank you, Alexandra, 341 00:14:35,434 --> 00:14:36,280 this was a lot of fun 342 00:14:36,280 --> 00:14:38,560 and thank you to listeners for spending their time with us. 343 00:14:38,560 --> 00:14:40,410 - For more information on palliative care, 344 00:14:40,410 --> 00:14:42,993 please visit uvmhealth.org/medcenter. 345 00:14:44,490 --> 00:14:46,250 - You've been listening to Health Source, 346 00:14:46,250 --> 00:14:49,440 brought to you by the University of Vermont Health Network 347 00:14:49,440 --> 00:14:52,000 which includes the UVM Medical Center, 348 00:14:52,000 --> 00:14:54,040 Central Vermont Medical Center, 349 00:14:54,040 --> 00:14:56,480 Champlain Valley Physicians Hospital, 350 00:14:56,480 --> 00:14:58,840 Elizabeth town Community Hospital, 351 00:14:58,840 --> 00:15:01,370 and Alice Hyde Medical Center. 352 00:15:01,370 --> 00:15:05,183 For more information, visit uvmhealth.org.