Your job first and foremost is to observe and learn.
Observe, observe, observe.
Most physicians trained in the last half century or so are not well-trained with respect to prognostication (in the past, the chief job of the physician, fatal or not? hopeless or not? sooner or later? etc.). Note with care how patients progress, and how quickly.
You can certainly learn by doing in the sense that you can most likely see patients, get histories, and perform exams. Be careful in communicating any preliminary assessment or plan before presenting to your attending.
The assessments and plans in H&PM are specialized and different from the focus of most of your previous education. They need to be congruent with the treatment goals for that patient and within the parameters and limitations of H&PM. Your attending has a particular practice style and practice environment; respect that and volunteer few opinions before you get to know your attending and the practice parameters well.
Both hospice and palliative care focus on helping patients be comfortable by addressing issues causing physical or emotional pain or suffering.
Palliative medicine relieves the pain and other symptoms patients suffer due to serious illness, including cancer, cardiac disease, respiratory disease, kidney failure, Alzheimers, AIDS, ALS, and MS. The goals of palliative care are to:
- reduce suffering,
- improve the quality of a seriously ill persons life, and
- support that person and their family during and after treatment.
Hospice care is for patients with a terminal diagnosis who are no longer seeking curative treatment. The focus of their care is on relieving symptoms and supporting them as they approach the last stages of life. The specialty brings special attention and expertise to the problems of such care to these patients with life-threatening, life-limiting and serious conditions, including treatment options, adjustments and interactions, including dosing adjustment.
The practice is universally run with integrity. Because in H&PM the margins are slim and the benefit is generally capitated, and doesn't cover things like procedures. Whatever bending of the rules that I've seen have to do with dis-enrolling patients from hospice back onto their primary coverage, to get one-time, expensive palliative procedures for optimal patient care done (like venting G-tube placement for impending GI obstruction, etc.), and then re-enrolling the patient back into hospice. This is done to prevent the program's budget from being busted, and keep the doors open for present and future patient.
Learn, learn, learn.
Resources:
http://www.eperc.mcw.edu/ff_index.htm
http://www.aahpm.org/cgi-bin/wkcgi/search
http://www.aahpm.org/resources/
and their parent URLs