Home Based Palliative Care (Residents in their second or third year only)

Contact person: Dr. Kirk Hamilton

Dr. Hamilton was initially trained as a family physician, however, has focused his practice working exclusively with palliative care patients.

Dr. Hamilton aims to match the individual resident’s unique learning objectives for this elective experience they wish to achieve while on this rotation with him.

PALLIATIVE CARE

Dr. Hamilton is the lead physician for the London Home Palliative Care (LHPC) Team and maintains a roster of 45-55 patients within their home environments. These patients have a wide variety of cancer and non-cancer (ALS, COPD, CRF, CHF, dementia, MS etc.) end stage illnesses, which allow the residents an exciting and unique opportunity to learn how to manage a wide range of clinical scenarios within the patient’s home.

Managing patients and their families with life limiting illnesses is a fundamental skill which is essential when working within many fields of medicine. The provision of high quality service to this group of patients and their families which focuses on compassionate, patient-centered, symptom based care directed at easing the suffering related to the patient’s end stage disease processes is mandatory when working with these patients. This is a very challenging and satisfying specialty of medicine and acquiring effective skills managing these patients will improve the resident’s care when dealing with this difficult, end of life patient encounters. The communication and clinical experience gained during this elective will help the resident in all their future patient encounters.

The content and learning objectives will be based on two levels of training which will determine the expectations and responsibilities for residents participating in this elective:

  • Level 1: For residents in their second or later year of training and entering their first month of a palliative care elective. Objectives involve patient assessment, clinical pharmacology and utilization of medications for symptom management, communication, and strategies for self-care.
  • Level 2: For residents who have had experience in palliative medicine, and requesting a fellowship level of educational elective experience. Objectives include those in level 1, as well as plans of care for patients with life-threatening illnesses, pain management, and evaluation and management of delirium, screening, evaluation and treatment of psychological disorders, spiritual and cultural aspects of palliative care.

A more detailed version of the specific learning objectives, resident’s expectations and responsibilities within each level will be available to the resident prior to the start of this rotation.

Details of the Palliative care component of the rotation:

  • Provide palliative care follow up home visits during the week day hours Monday to Friday. There will be several opportunities to perform the initial palliative care consultation (urgent and semi-urgent) during this elective time.
  • Participate in didactic “case of the week” exercises which will challenge the resident’s management plans related to interesting clinical palliative care scenarios.
  • Dr. Hamilton occasionally covers the inpatient palliative care consultation service and the 14 bed inpatient palliative care unit and the resident may have the opportunity to contribute with the management with these patients while Dr. Hamilton is covering this service.
  • Call responsibilities: Home call and the resident would be on first call for a maximum of one in four. The call is not onerous and most calls can usually managed by phone. There is no expectation to travel to a patient’s home after daytime hours.
  • The ability for the resident to have their own transportation to the house calls would be a mandatory requirement of this rotation.
  • Most programs offer a home call stipend for this rotation.
  • Dr. Hamilton is available for guidance and mentoring for all visits.
  • Dr. Hamilton will accompany the resident for several house calls during the rotation for an enhanced didactic learning experience. The majority of the resident’s house calls will be performed independently, however, reviewed by Dr. Hamilton prior to signing off the patient encounter and is always available for guidance and support during all patient encounters.
  • All home visits will be done during day time hours (no mandatory night time visits and rare weekend home visits).
  • You are never required to provide care to patients if you feel your safety is in jeopardy. Use common sense and avoid any possible situations in which your instincts make you feel that the situation is possibly dangerous for you. Call Dr. Hamilton or 911 if you are
    uncomfortable in any clinical situation that may arise while on home visits. Dr. Hamilton follows the safety policy for “family medicine experience on call” (“During house calls or clinic work outside regular working hours, the safety risk must be determined beforehand. Under most circumstances, the resident should be accompanied by another person during these activities. If the resident is to attend a home visit or clinic alone, the patient and/or his/her home environment must be well known to the supervisor* and resident, the overall safety risk is either low or negligible, and both the resident and supervisor* must be comfortable with the arrangement. Additional safety measures may be instituted as necessary by the resident and his/her supervisor*.”) Dr. Hamilton will have already assessed the patient within their home and would never ask the resident to assess a patient in a home if there are any questions related to a resident’s safety. If during or after any patient or family encounter, the resident is not comfortable continuing to follow a particular patient or family within their home for any reason, future house calls to that home by the resident will cease! Dr. Hamilton will continue such house calls on these patients under these circumstances which will likely be an extremely rare occurrence.

If you have any questions or would like to plan your call schedule in advance, please contact Dr. Kirk Hamilton at drkirkhamilton@gmail.com

Residents will be expected to submit their specific learning objectives for obstetrics and palliative care prior to beginning their rotation in order for Dr. Hamilton to plan your elective time. Dr. Hamilton will strive to achieve these individual resident requested learning objectives which will be reviewed at the end of their rotation.

If you have an interest in this elective, please request your preferred month in advance as the availability for this experience is limited.