As the U.S. population ages, with the probability of more chronically ill patients in hospitals, more physicians should get acquainted with advanced care, not only for quality reasons but also as an improved economic tool, Stuart says.
"In our way of thinking, we are reducing costs the right way," Stuart adds. "You are preventing readmissions, having incredible savings, and letting patients say what they want, and make sure they get that. I made the mistake for so many years just assuming my job was to diagnose and treat the patient."
Like many physicians, Stuart says that was part of his medical training. During his first two years at Stanford Medical School, he says it was thrilling, with Nobel Prize winners as teachers, and he studied internal medicine, clinical psychology, and neurology.
"It was very intoxicating, but then I went into the wards and immediately realized we were doing something very wrong," Stuart recalls. "We were literally treating people to death. I was horrified." He saw that many procedures were done on patients with devastating illness, yet they still died "pretty quickly."
At the beginning his career in palliative care, there were only a few hospital programs in the country, and some hospital officials maligned them as not being cost effective, Stuart says. Just being in such programs made him and others feel as if there were a lack of support as time passed and they pushed for greater support for advanced care. "Developing advanced care as a step beyond palliative care was like pushing a rock uphill," Stuart says. He kept at working for palliative care. "It just stubbornness."