How Doctor and Doula Partnerships Transform End-of-Life Care

ABSTRACT

The author of this article, Bob Uslander, MD, is a board-certified emergency medicine specialist who has transitioned to private practice that focuses on palliative and end-of-life care. His practice blends hospice-style care offered as a “concierge” (direct-pay) service. Through his experiences, Uslander has learned the value of approaching palliative care with a multi-discipline team of caregivers.

For example, partnering with an end-of-life doula can revolutionize a physician’s care to transform how people — patients, family members, and community — experience the final chapters of life. An article published by Sage Journals in its Palliative Care and Social Practice found that “patients who received care from an end-of-life doula (or ‘death doula’) increased their death literacy, leading to a sense of personal empowerment, positive end-of-life experiences for the family, and personalized deaths for patients.”

Traditional, insurance-financed hospice care does not cover critical elements of care needed by end-of-life patients and their loved ones. These elements include:

• Companionship and presence. Just being there for the patient and loved ones provides solace, guidance, and support to reduce feelings of anxiety and isolation.

• Comprehensive care. The partnership with a physician helps assure holistic care covering all aspects of the patient’s (and family’s) well-being.

• Emotional and spiritual support. Non-physical care helps patients and family find peace and meaning as they approach the end of their lives.

• Education and advocacy. This relationship provides opportunities to ensure patients and family understand options and expectations. Clarifying wishes and advocating for those final wishes are a big part of doula care.

• Rituals and resources. For many — particularly those without religious experience — a well-trained death doula can provide ideas and resources to incorporate appropriate rituals during this journey.

• Enhanced communication. The connections and relationships that grow between patients and doulas open up wider opportunities for effective communication between medical providers and patients, as well as other service providers as appropriate.

EXPERT COMMENTARY

Not only does this article offer another success story about a doctor creating an alternative career, but it also provides insight into how he managed to address problems that he saw first-hand from day to day. As an ER physician, Uslander watched a lot of patients and family members suddenly caught up in the throes of end-of-life questions, obstacles, and emotional trauma. That awareness — fueled by a partnership (and marriage) with a social worker/spiritual advisor — uniquely prepared him for diving into hospice and palliative care. They established a brand new provider organization that did not have to depend on the highly limited guidelines and resources provided by third-party payers.

Their multi-disciplinary marriage became a multi-disciplinary care model for people managing end-of-life services. This Psychology Today article describes the benefits of including a “death doula” in the care team — something rarely, if ever, paid for by insurance. But like the better-known “birth doula,” these professionals bring tremendous value to the care being offered. The Uslanders’ services are made possible, in part, through funding raised through their related 501(c)(3) foundation.

There is a recipe for success in all of this: A reliable partner who shares or co-develops your vision for a particular endeavor; a good, broad network (the Uslanders leveraged connections in hospitals, physician groups, and the counseling/ social work industry); creative determination to find a way when it appears there is no way (the non-profit angle in their case). These elements empowered the Uslanders to raise awareness of needs that they have been equipped to meet.

Source: Bob Uslander, MD, Psychology Today, October 2, 2024; https://www.psychologytoday.com/us/blog/permission-to-choose/202410/how-doctor-and-doula-partnerships-transform-end-of-life-care