When the Doctor
Prescribes Ice Cream

“My sister and I were still trying to treat Mom as if nothing were wrong,” says Cathy Parry, who lives in Loudon, New Hampshire. “When you love someone, it’s hard to change the way you treat them. We needed to lower our expectations.”

Uldine’s longtime doctor, Julia Burdick, MD, an internal medicine physician at Dartmouth Hitchcock Clinics Concord in Concord, New Hampshire, helped Cathy and her sister understand the reality of Alzheimer’s progression.

“Dr. Burdick gave us ideas about how to make life more comfortable for our mother,” Cathy says, recalling mealtime challenges. “We knew Mom had to eat in order to stay alive. Dr. Burdick helped us change our perspective, and we started thinking more about Mom rather than ourselves. We would put food in front of her, but if she didn’t want it, that’s just the way it was. My mom loved ice cream, so sometimes she’d eat some ice cream before bed. It was not as nutritious as we would have liked, but it wasn’t about us; it was about Mom.”

Now, Burdick is working to ensure that other patients and their caregivers can have access to the same information and personalized care choices. Along with another Dartmouth Health physician, Henry Feng, MD, Burdick is building a model to integrate palliative care—traditionally an inpatient specialty—into primary care settings, bringing this approach to more patients when they need it.

Care for What Matters Most

Palliative care is different from end-of-life care—it’s for anyone with a chronic condition that affects quality of life. This type of care includes easing symptoms such as pain and sleep problems; providing support for emotional, spiritual, and physical needs; and helping patients make healthcare decisions that align with their priorities. For example, a patient with fatigue might want to enjoy a family outing; the solution could be medication to give the patient enough energy to join the fun. Or, as in Uldine’s case, it could be reducing stress around mealtimes by helping the family understand what’s realistic.

At the crux of this approach is the question of how a patient wants to live, says Feng, an internal medicine physician at Dartmouth Hitchcock Clinics Concord and a clinical assistant professor at the Geisel School of Medicine at Dartmouth. “Modern medicine can keep a person alive,” he says, “but are they enjoying their quality of life?”

Right now, palliative care is largely treated as a specialty, with patients having to see an additional provider to develop palliative-informed care plans. Without them, a patient’s symptoms can sometimes land them in the emergency room unnecessarily.

And there, “our default is to provide all life-sustaining measures, but that might not be what the patient wants,” says Susan Varga, MD, an emergency medicine physician at Dartmouth Hitchcock Medical Center and an assistant professor at Geisel. Burdick and Feng’s model aims to not only empower patients and caregivers to take the right steps for their unique priorities, but also provide a roadmap for other providers they may encounter, too, such as specialists, home healthcare workers, or visiting nurses.

When patients have talked with their primary care doctors about their goals for care before a crisis occurs, Burdick says, healthcare providers can have confidence that they are acting morally and ethically, even if the patient’s treatment isn’t standard protocol.

Expanding Options

In the initiative, Burdick and Feng are developing ways to identify patients, like Uldine, who would benefit from outpatient palliative care intervention. To expand reach and maintain quality care, nurses, social workers, and other providers—not just palliative care specialists— will be trained to administer a new standardized screening tool, which can be used, for example, when a patient is discharged from the hospital.