When patients live far from care, video conferencing can be a palliative support lifeline

Re-post article by Michael Novinson from crn.com

People facing life-threatening illnesses often access palliative care to ease their pain and help with difficult end-of-life choices. But for those living in remote, rural areas, getting that comforting care can be unwieldy. Special correspondent Joanne Elgart Jennings reports on how one doctor in Northern California is trying to come up with innovative ways to ease the process.


JUDY WOODRUFF: People facing life-threatening illnesses often turn to palliative care, not only to address their pain, but also to navigate end-of-life choices. It’s never an easy process, but it’s even harder for those living in remote rural areas.

One doctor in Northern California is finding innovative ways to help ease the burden.

Special correspondent Joanne Jennings reports from Humboldt County, California. It’s the latest in our Breakthroughs series on invention and innovation.

JOANNE JENNINGS: Dr. Michael Fratkin, an internist specializing in palliative medicine, is making a house call to a terminally ill patient.

WOMAN: This is where I would like to die when I die, in my own bed, in my own home.

JOANNE JENNINGS: At 73 years old, Kristi Goechel is confronting her mortality. Six months ago, the retired school guidance counselor was diagnosed with an aggressive form of pancreatic cancer. Her oncologist recommended surgery and chemotherapy, but Goechel to forgo treatment.

KRISTI GOECHEL, Retired Guidance Counselor: My husband was in the hospital for a long time before he died. And it was painful. I don’t want to live the rest of my life like that. If I have three months, six months, I don’t care. I want quality of life with my family.

JOANNE JENNINGS: Now home, Goechel is savoring every moment.

KRISTI GOECHEL: I get a lot of pain.

DR. MICHAEL FRATKIN, Resolution Care: And then where’s the pain?

JOANNE JENNINGS: Like most palliative care doctors, Fratkin does manage pain. But he also tries to get his patients to focus beyond the physical.

DR. MICHAEL FRATKIN: How are you feeling inside yourself?

KRISTI GOECHEL: Well, I’m feeling better. I was feeling pretty crazy inside myself for a while. And I’m trying to work that out now emotionally.

JOANNE JENNINGS: To offer this kind of personal care requires time. But with most of his patients living off the beaten path, far from Fratkin’s office in Eureka, that’s almost impossible.

To give us a better sense of the distance he covers, Fratkin enlisted the help of pilot Mark Harris and his 1957 Cessna.

DR. MICHAEL FRATKIN: Just our service area extends 100 miles north and south and probably 60 to 80 miles from the beach eastward. There are people that live in the nooks and crannies of our environment by choice. That’s where they have lived their life and that’s where they want to complete their life.

A little bit more than a year ago, I was burned out. I had no team and no way of thinking, how was I possibly going to meet the demand that this community has for this kind of supportive care?

JOANNE JENNINGS: So he came up with a solution: videoconferencing.

DR. MICHAEL FRATKIN: By adding the videoconferencing technology, we can travel that distance instantaneously.

And as long as our relationships are solid and we have delivered an environment of trust in working with these folks, it works beautifully well

JOANNE JENNINGS: For 44-year-old Rich Schlesiger, this type of communication makes all the difference. The former sheriff’s deputy had been making a 10-hour round-trip drive to San Francisco for brain cancer treatments.

After trying everything, his tumor continued to grow, so he made a tough decision: stop chemotherapy, and live out his final days at home in Fortuna.

From his living room couch, with his wife, Morgan, and mother, Pam, by his side, Schlesiger discusses his drug regimen with his neuro-oncologist, Dr. Jennifer Clarke. She’s in San Francisco. And Dr. Fratkin is in Eureka.

DR. JENNIFER CLARKE, University of California, San Francisco: How did that go? Did you feel like it made any difference from the standpoint of headaches or from the standpoint of your right side?

WOMAN: I don’t think so.

JOANNE JENNINGS: After sharing a few laughs, they quickly move into an intense conversation.

DR. MICHAEL FRATKIN: How is the rest of your family around you doing, Rich?

RICH SCHLESIGER, Retired Sheriff’s Deputy: It’s rough because I don’t know where to go, you know? I feel good. Then I’m like going down, you know? And I’m like, God damn it, something’s wrong. But you know how I am? I just want it — I want to do it. And that’s how I am.

DR. MICHAEL FRATKIN: If I was to be a betting man, I would bet that this would be in some ways the hardest part of things, because it’s not about doing. It’s about being.

WOMAN: It’s good that he’s showing those emotions. It’s good that he has all that. It’s just the part of Rich that we love.

JOANNE JENNINGS: Pam Schlesiger says that videoconferencing has made this very difficult process more bearable.

PAM SCHLESIGER, Mother of Rich Schlesiger: He gets to talk to Dr. Clarke and Dr. Fratkin, and here we are in our house. Who would even think of that?

JOANNE JENNINGS: Dr. Clarke, who hadn’t done video consultations before meeting the Schlesigers, is impressed.

DR. JENNIFER CLARKE: This was my first experience with telemedicine. And I found it, in fact, much more powerful than I was anticipating. And I think this could be a really powerful tool to allow us to take better care of patients, particularly when they’re becoming less mobile toward the end of life.

JOANNE JENNINGS: But, despite the promise, Dr. Clarke doesn’t yet have a mechanism to bill for video consultations.

For Dr. Fratkin’s older patients, Medicare often pays after an initial face-to-face visit. And through a new pilot program for Medicaid patients, he’s trying to replace the traditional fee-for-service system with a so-called value-based payment model.

Here’s how it works:

DR. MICHAEL FRATKIN: For eligible participants, we will be provided a per-member per-month amount. With this value-based payment model, it doesn’t matter whether we see the person once a month or twice a day. It doesn’t matter if we send a social worker or a community health worker. It doesn’t matter if we use a telephone or we use a videoconferencing technology.

What matters is that we deliver value that makes sense to that person.

JOANNE JENNINGS: Meanwhile, Fratkin is helping his patients get used to the whole concept of palliative care via videoconference.

DR. MICHAEL FRATKIN: And then, what we will do is, we will connect by videoconference.

JOANNE JENNINGS: Kristi Goechel says she prefers in-person visits, but she will give video a try.

For the PBS NewsHour, I’m Joanne Jennings in Redway, California.