Palliative Medicine is patient and family-oriented Family Medicine in the setting of progressive serious medical illness. All of our TFM Faculty are committed to and skilled in providing this service to our patients. We strive to have our graduates feel competent and comfortable serving patients throughout their life journey.
Residents gain experience in both the inpatient and outpatient setting with close supervision and mentorship from Dr Van Buskirk, our experienced and compassionate, Board Certified Palliative Consultant and the Palliative Medicine Consultation Team. Interns spend time seeing new consults and follow up patients/families alongside Dr Van Buskirk reviewing Advance Care Planning for inpatient/outpatient settings, 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 coordinate the Family Meeting to be at a time the Resident can be present with Dr Van Buskirk. We review 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 with an educational debrief 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 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 frontlines of addiction treatment. TFM has incorporated medication assisted treatment (MAT) of opiate addiction with buprenorphine/naloxone into the curriculum. 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 and 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 for all staff. 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 where residents can rotate during their elective time. 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 has become part of the basket of services provided by 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.