Palliative Medicine is patient/family-oriented Family Medicine in the setting of progressive serious medical illness. All Family Physicians need to demonstrate a minimum competency in this area. All of our TFM Faculty are very committed and skilled to do this.
Each Intern is scheduled for a half day with Dr Van Buskirk, our very experienced, Board Certified Palliative Consultant and the Palliative Medicine Consultation Team seeing new consults and follow up patients/families. We review Advance Care Planning for inpatient/outpatient settings to include the importance of DPOA-HC and POLST Forms. We review practical aspects about Hospice, in anticipation of the Resident spending time on multi-disciplinary Hospice visits.
When Residents on our Internal Medicine and Family Medicine inpatient services place a Palliative Medicine referral—we do our best to coordinate the Family Meeting to be at a time the Resident can be present with Dr Van Buskirk. We review in advance the clinical context, the structure of the Meeting (with a Checklist), and the role of ultimately making specific recommendations to a patient and family about the best medical care to match the patient’s medical situation and individual goals. The Resident is encouraged to take the lead in running the meeting with real time support from Dr Van Buskirk. We then debrief the meeting afterwards.
Dr Van Buskirk is available formally or informally to discuss Palliative oriented issues at any time during the course of the three year Residency. Every Resident is encouraged to schedule some Elective Time with the Palliative Medicine Consultation Team.
Medication-Assisted Therapy for Opioid Dependence
Opiate addiction is an alarming epidemic that continues to progress throughout the United States especially in Washington state. Primary care physicians are leading the way on the frontlines of addiction treatment. TFM has incorporated in the curriculum medication assisted treatment (MAT) of opiate addiction with buprenorphine/naloxone. We pride ourselves on continuing to evolve our MAT curriculum as the tides of treatment have moved progressively towards risk reduction and low barrier interventions. TFM strives to provide our patients the opportunity to receive care not only for addiction but also for their full spectrum needs in a non-judgmental atmosphere. All physicians at TFM have the opportunity to obtain their waiver and everyone participates in the care of our patients experiencing opiate addiction and dependency.
TFM as well as our sponsoring institution, MultiCare, are dedicated to providing a safe space for all LGBTQIA+ patients and employees. We realize that we can only provide quality and compassionate care if our patients feel comfortable not only disclosing their gender and/or sexual identity but living as their true selves. TFM staff has been trained to provide sensitive care to all LGBTQIA+ patients. MultiCare has partnered with a Tacoma based queer organization to develop educational teaching modules that all staff complete. Our electronic medical record is structured so that gender identity and sexual orientation information are easily accessible, and patients do not need to continuously disclose. It also allows for preferred names and pronouns, independent of what name is on a license or insurance card, to help to prevent misgendering or misidentification. MultiCare Mary Bridge Pediatric Hospital also has a Gender Health Program that provides gender-affirming care and residents are welcome to rotate. Our residency understands that gender-affirming hormone care should be an essential skill of any full-scope family medicine physician and all providers are trained to be able to provide this service to adults. The road to full equality within medicine for all LGBTQIA+ individuals is long but TFM is dedicated to walking this journey with all our patients and staff.
Point-of-care ultrasound (POCUS) continues to expand and be pertinent to family medicine clinicians. At TFM, we have a longitudinal POCUS curriculum including didactics and workshops and a plethora of resources. In addition, POCUS is used on rounds with TFM attendings, in clinic, and in the emergency room with the ED or trauma providers. Our TFM clinic offers a SonoSite X-Porte Ultrasound machine complete with learning modules, and multiple faculty have portable Butterfly Ultrasound devices for increased ease of use. For those POCUS enthusiasts, a focused POCUS elective with emergency medicine providers and interventional radiology can increase your hands-on skills and procedural competency.