For a man who has seen hundreds of patients at the end of their lives, you wouldn’t imagine he would call the work he does “remarkably rewarding.” However, for Dr. Daniel Hoefer, a family medicine and palliative care doctor with Sharp Rees-Stealy Medical Group, what he does is a calling — one that allows him to provide truly patient-centered care to those he treats and their loved ones.
Dr. Hoefer has worked with Sharp Rees-Stealy for more than 28 years. His practice was recently moved to the new Sharp Rees-Stealy Santee Medical Center, which was built to make it easy for patients in East County to receive award-winning care at one convenient location.
He sees patients daily as a family medicine doctor, but has always been drawn to palliative medicine. Palliative medicine is defined by the World Health Organization (WHO) as an approach to care that improves the quality of life for patients facing life-threatening illness by preventing and relieving the patients’ suffering.
“There is a need to improve and expand palliative care,” Dr. Hoefer says. “I am blessed to be partnered with such wonderful people who agree.”
The importance of quality palliative care
High-quality palliative care provides relief from pain and other distressing symptoms, affirms life, and regards dying as a normal process of life. It uses a team approach to address the needs of patients and their families, including bereavement counseling, and offers a support system to help patients live as actively as possible until their death.
“It is imperative that the treatment we provide is consistent with a patient’s goals,” Dr. Hoefer says. “Truly patient-centered care means that we honor what the patient values most, whether that’s being able to remain in their home, maintain cognitive clarity or be able to move about without pain.”
Not satisfied with the traditional standard of care for older adults, which might treat a patient’s illness or injury but create unintended consequences, such as impaired cognition or increased frailty from surgery or other treatment, Dr. Hoefer and colleagues developed the Transitions Advanced Illness Management Program. The program works in conjunction with a patient’s doctor to design an individualized care plan that takes into account a patient’s physical, emotional and spiritual values and needs.
“It was important to develop a system that understands older patients and the process of aging,” Dr. Hoefer says. “The Transitions program offers those we treat a much better pathway in the bell curve of their lives. It’s better for patients and their families.”
Weighing risks and benefits of care for seniors
Dr. Hoefer says that having a surgery or being hospitalized has to be balanced against the unintended consequences of well-intended care. We may be able to improve the function of an elderly person’s knee, but it will be at the expense of declining cognition and a tremendously increased risk of developing dementia, functional decline and social isolation.
“The pandemic is truly allowing us to witness the consequences of social isolation of seniors,” he says. “For the elderly, social isolation is the greatest predictor of mortality after smoking. It can lead to depression, delirium, weight gain, suicide ideation and death. We are social animals and we need to socialize to survive.”
As such, Dr. Hoefer recommends that families ensure their older loved ones can remain connected to others and have a sense of purpose, whether we are in the midst of a pandemic or not. He also advises older adults to shower and get dressed each day, avoid sitting for long periods of time, attend religious services or other activities — even if online or from a car — and take opportunities to get outside to sit in the sunlight or take a walk.
“In Okinawa, Japan, they believe in the importance of ‘ikigai,’” Dr. Hoefer says. “This means having purpose, which can lead to a long, healthy life. This, along with proactive care, tailored to what each individual patient most values, is our goal for every person we treat. This is true patient-centered care.”