Thompson physician embraces two specialties: emergency medicine, palliative care
By Chris Motola
Q: You practice an unusual combination of specialties: emergency medicine and palliative medicine. Which did you start with and how did you come to be interested in the other?
A: I did emergency medicine first. I trained in Wisconsin and then practiced emergency medicine for around five years. I found that there were some themes that came up in emergency medicine one of which was seeing people with a lot of chronic disease who would come to the ED and then need a lot of emergency medicine-based testing done that ultimately didn’t help them feel better or provide more clarity on why they were sick. So it seemed like there was this cohort of patients who were missing out on symptom management and support. That started to shift my interest toward how to take care of that population outside of the ED.
Q: What types of patients would this describe?
A: I always felt like taking care of cancer patients in the ER was a difficult but meaningful experience because when they hit the ED they’re usually pretty sick and there’s a lot of complexity in figuring out why they might be sicker. And, in some ways, I just felt a connection to that population in terms of providing care for them. Palliative care gives me some upstream interaction with these patients before I see them in the ER. So that cultivated an interest. I also knew an ED doctor who had transitioned into working in palliative care. And he wrote these notes that were unlike any other notes I’d read. They kind of addressed the whole of the person instead of just the medical problem, like maybe things were more complex for that person. I wanted more of that in my life, so I reached out to him and that started the process of getting into a fellowship and training.
Q: I think a lot of people tend to confuse palliative with hospice care since they’re often paired together. How would you describe it in the context of emergency medicine?
A: It’s a little tricky to answer in terms of how it integrates into emergency medicine. It’s parallel care throughout the healthcare system. It’s symptom management care for people who are receiving active treatment for all sorts of different diseases. We’re focused on making sure that, despite the treatment of the disease — some of which can make the patient sicker in the process of getting better, like chemotherapy — we’re managing the leftover symptoms whether it’s pain, shortness of breath, anorexia, nausea. So we’re doing parallel treatment for that in a way that has nothing to do with hospice.
Q: What would be an example of how that upstream and parallel knowledge can help you be more effective in the ER?
A: Someone described palliative medicine as being a black bag specialty. To me that means it’s a really individualized approached, like if you were seeing a patient at home. It all plays into the person’s life beyond the disease. When they’re in the ER, I’ll know what they need in terms of testing, but I also might know what it is they want to talk about in terms of what they want to get out of the visit. We may want to go through it like any other ER visit and often that will be the case since they’re there for ER medicine. But when we get results from the test there’s a better sense of what we do with that info. Sometimes it helps shape a different plan even if they’re admitted to the hospital, in which case I’ll see them there in my palliative care role. And it helps them because they know me from another context. While it’s unfortunate in one regard, I do get a lot of professional satisfaction from being able to follow them from one context to another. And I do oversee palliative care in a hospice context as well, so if patients do get sicker I can help them understand what those services offer.
Q: How important is institutional support in balancing these roles?
A: It’s of very high-level importance. FF Thompson has been supportive of the entire process. When I left to do the fellowship training and looking for a way to combine the two jobs, Thompson created a position to combine those job descriptions. The University of Rochester was also very supportive of the appointment process part of it. It’s been really helpful to have all the professional connections that I have with people through that division even working exclusively through Thompson. There’s a lot of opportunity to collaborate on very complicated cases. I don’t think it would have even been possible without a supportive community institution and the affiliation with a supportive university system. I talk to people who do these types of splits and I think what I have here is very unique.
Q: How do you allot your time between the two?
A: I basically have a 50/50 split between emergency medicine and palliative care.
Q: The pacing of those two specialties has to be very different. How do you switch between them effectively?
A: There is a huge difference when there’s no overlap. The skills I have in palliative care help with understanding pain medications and things like that, but for the most part it’s its own thing. With palliative medicine there’s probably more integration of emergency medicine because these cases are usually pretty complicated. There are some days where it’s harder than others to flip between roles, but more and more it just feels like a spectrum of care. I’m not a surgeon, but it might be comparable to being in the operating room versus the clinic.
Q: Do you have any advice to other physicians who are looking to adopt hybrid practices?
A: I think mentorship is pretty important but also just finding something you’re interested in, have the aptitude and can persevere in along with whatever primary training you’re in. I think mentorship can really help with that. When you partner with someone who trusts and sees your potential you can gain the confidence to pivot to something that may be difficult but can open up more opportunities to you.
Lifelines
Name: Adam Cardina, M.D.
Position: Emergency medicine and palliative care physician at FF Thompson Hospital
Education: Medical College of Wisconsin; University of Rochester Medical Center
Certifications: American Board of Emergency Medicine
Hometown: Trumansburg
Affiliations: FF Thompson Hospital; Strong Memorial Hospital
Organizations: UR Homecare Board
Family: Wife, three children
Hobbies: Outdoor activities, water sports, skiing, music, cars