25th Anniversary Message from our Chief
10 years ago I was attending on the palliative care consultation service and the medical student rotating with us asked when the Palliative Care Service started. I told her it was in 1999. She thought for a moment and then asked, “What did we do before palliative care?”
I have thought about that question a lot over the years and how it seemed impossible for our student to imagine caring for seriously ill people without palliative care. Yet, when I arrived at UCSF to start medical school in 1985 there was no palliative care, but there was a new pandemic, a health crisis that was killing, predominantly, young men and San Francisco was at its epicenter. That crisis was AIDS. It was through caring for people with AIDS at UCSF and SF General that I and many of my colleagues learned palliative care. We didn’t have a name for the care we were providing, but in supporting people with what was then a nearly universally fatal disease - helping them choose treatments that reflected their values, ensuring they received the care they wanted, relieving their symptoms and giving comfort, and offering emotional, psychological and spiritual support - we were providing the core of what we now know as palliative care - that we define as: medical care focused on improving quality of life for people with serious illness.
"I have thought about that question a lot over the years and how it seemed impossible for our student to imagine caring for seriously ill people without palliative care."
In 1998 we decided to do something to address a gaping shortfall in care. Based on caring for people with AIDS and in response to a growing body of research that found that people with serious illness and those nearing the end of life experienced unrelieved pain and other symptoms, often received care they did not want and from which they did not benefit, and their loved ones’ emotional, psychological and spiritual needs went unaddressed. A group of us - nurses, social workers, chaplains, physicians, and administrators - met to plan a new service dedicated to meeting the needs of people with serious illness - AIDS and many others - and to the idea that while we could not make death and dying good, we could make it better. There were few models to adopt, but we learned from the few there were and on March 9, 1999, we launched the Palliative Care Service at Moffitt-Long Hospital - the first Palliative Care Service at UCSF and among the first wave of services in the country. We saw 112 patients in our first year and never looked back. Today we tell our patients that our goal is to help you live as well as possible for as long as possible.
Ever since our launch in 1999, UCSF has been at the forefront of the growth and development of palliative care. We see our patients as people with illness and a broad range of issues and challenges that accompany serious illness, for them and their loved ones. We know that social workers, chaplains and doctors working together closely is the way to ensure that we meet the needs of our patients. In 2005, we launched our outpatient palliative care service for people with cancer, the Symptom Management Service, in 2017 launched the OPCS - outpatient PC service for people with illnesses other than cancer and in 2021 we launched our inpatient hospice service in collaboration with our partners at By the Bay Health. Growing from our first year with 112 patients we now care for over 10,000 people a year, with every type of serious illness and in every setting of care - clinic, hospital, skilled nursing facility and at home through telemedicine.
"We saw 112 patients in our first year and never looked back. Today we tell our patients that our goal is to help you live as well as possible for as long as possible."
Embracing the entrepreneurial spirit that is so vibrant at UCSF, we set to work building our field. In addition to establishing and growing our own clinical services, as part of the UCSF Palliative Care Leadership Center, we have worked closely with teams from nearly 300 institutions across the country including every public hospital in California to help them start palliative care services. Today over 100,000 people a year receive care from the teams we helped to start. We have become leaders in palliative care education and train specialists through our nationally recognized fellowship program that includes 7 physicians a year in adult, pediatric and combined geriatric palliative care and scores of students from all health professions who rotate with us and learn from our team. We have the MERI Center for Education in Palliative Care, which has reached more than 5,000 people across the world and online during the last few years of its Poetic Medicine program. We have Practice-PC training scores of people from all disciplines to be able to take palliative care back to their home institutions. We conduct research to learn how best to provide palliative care and are innovation leaders in Advance Care Planning, communication, resiliency, and care delivery. We are deeply committed to diversity, equity and inclusion in every aspect of our work and have active outreach programs to recruit a diverse group of students, fellows, faculty, and staff to the DPM and to palliative medicine and conduct research and quality improvement to ensure equity in access to our services.
In 2018, we were proud to reach another important milestone when our services became a formal Division within the Department of Medicine, the Division of Palliative Medicine. The Division brought together people from every discipline across UCSF Health to advance our core missions of clinical care, education, and research. We approach every aspect of our work with a deep commitment to diversity, equity, and inclusion and interprofessional work.
As we celebrate 25 years of palliative care at UCSF, we are proud of all that we have accomplished to improve the quality of life and care for people with serious illness and their families. We are proud of the profound service we have provided to tens of thousands of patients and caregivers, the education we have taught to thousands of learners, and the hundreds of important research studies and quality improvement projects we have done. We are grateful to our many colleagues at UCSF and beyond, honored to have served the people who have invited us into their lives, and the many generous funders for their staunch support over the last quarter century.
While we take time this year to savor and celebrate how far we have come, our hearts and minds are focused solidly on the future. We have made great strides in increasing access to interprofessional, specialty palliative care here at UCSF and at institutions across the country through our PCLC training program. At the same time, we know that there are 5 to 10 times that many people with serious illness who would benefit from palliative care and don’t receive it. We are fiercely committed to ensuring that every person with serious illness receives the palliative care they deserve and need. Closing this gap is the greatest challenge we face and the one we are committed to meeting. We will train more specialists in all specialties and disciplines, innovate new models of care including by harnessing the electronic health record and artificial intelligence to identify the people with serious illness who benefit the most and make sure they get the palliative care they need, equitably and without bias. We understand the great rewards of palliative care - of bringing our humanity, compassion, and expertise to care for the sickest among us - and want to share our excitement and enthusiasm with impassioned future palliative care providers who we hope will choose to join our field. We are working hard to attract more people to our field and create jobs that are professionally rewarding and personally sustainable within a Division that provides support and a sense of mission and community.
"...we know that there are 5 to 10 times that many people with serious illness who would benefit from palliative care and don’t receive it. We are fiercely committed to ensuring that every person with serious illness receives the palliative care they deserve and need. Closing this gap is the greatest challenge we face and the one we are committed to meeting."
Our 25th anniversary is also an opportunity to recommit to our core values of caring, compassion, kindness, courage, honesty, curiosity, and excellence - for our patients and their families, our colleagues, our students and each other. We affirm our pledge to see each person as a unique, invaluable human being deserving of respect, kindness and expert care.
“Tell me, what is it you plan to do with your one wild and precious life.”
- Mary Oliver
Our work in the DPM is fundamentally one based in hope - hope for comfort and respite in the face of suffering, hope for healing and glimmers of peace even when cure is not possible, hope for all that can still be achieved in the face of serious illness. For all of us to courageously ask and answer the essential question posed by the poet Mary Oliver, “Tell me, what is it you plan to do with your one wild and precious life.”
We need you. Your support, your voice, your interest is vital in our mission to serve our community. Years ago my student asked, “what did you do before palliative care?” 25 years ago I could not have predicted how far we would come and how much we would achieve. We cannot know the future, but I am confident that with our spirit of curiosity, innovation, hard work, and passion we will build and the care that 10 or 20 years from now people will ask how we possibly could have done without. We are excited about the future. Please join us as we look ahead to the next 25 years and beyond.