Second Interview with Jack Gordon
[Note: Mr. Gordon served as Chairman and CEO of HFA until his death in 2005.]
Jack D. Gordon is the Chairman of the Board and CEO of Hospice Foundation of America. He was the first Director of the Institute of Public Policy and Citizenship Studies at the Jack D. Gordon Institute of Public Policy at Florida International University. He served as a Florida State Senator from 1972-1992.
Q: Why has HFA chosen to focus on the subject of pain management for its 2006 teleconference?
A: Pain underlies a fundamental question. Why do we go to the doctor? Because something hurts. Yet for years, medicine in the US has relegated pain to the bottom of the list; it is treated with medications and by specialists, rather than being considered an integral part of a person’s symptoms and overall health.
One major concern that people voice about fears at the end of life is being in pain. Hospice can assure people that this is something they will not have to face. Hospice doctors say that in 99.5% of all end-of-life situations, patients can be kept pain-free. But more importantly, those people can be kept lucid and alert; this is a critical piece of the expertise of hospice professionals.
Q: What are some of the major issues that you’ll be looking at in the teleconference?
A: Well, we’ll certainly look in detail at the body of clinical knowledge developed and perfected by hospice clinicians, and some of the barriers that hinder incorporation of that knowledge into the larger health care system. We’ll also be working to expand the knowledge within the hospice provider world. I’ll be participating in the section on policy issues, where there are salient issues to explore.
One problem is in the enforcement of federal drug laws. Physicians may now be rightly concerned about prescribing medications. Because they are overseen by the DEA, doctors are easy to investigate. This requires a public discussion of the misguided zealousness of the DEA. One of the panelists who will join us on the program is W.A. Drew Edmondson, the Attorney General of Oklahoma, so there will be some interesting discussions about the public policy aspects of these issues. Also, the Supreme Court has begun hearing arguments in Gonzales vs. Oregon, so pain medications and government oversight are issues in the news right now.
Q: Hospice professionals are uniquely qualified to deal with pain management and symptom control. What are some of the issues they face in their work?
A: The law enforcement question is constantly looming. Yet as new drugs come on the market, professionals have increased ways to deal with pain. In the last few years, there has been a lot of attention on broadening hospice admissions to non-cancer patients. These diagnoses, such as end-stage Alzheimer’s or other related dementias, bring new opportunities and challenges to hospice professionals in how to communicate with and treat pain in these populations.
Q: What are some of the barriers that people face in receiving good pain management?
A: One area is in the manufacture of the medication itself. I suspect that less attention is paid to research in the area of pain medication, as opposed to medication focused on cure. It would be interesting to explore the idea of economic incentives for drug companies that would pursue this type of research.
Until recently, pain management was not a significant subject matter in the training of doctors and nurses! It is critical to continually reinforce the idea that severe, uncontrolled pain is not acceptable or unavoidable, whether at the end of life or any time. Many myths exist around pain medications, especially in terms of the fear of addiction. These myths may even influence doctors’ decisions, in part because of the recent activities of the DEA. And of course, these myths abound in general society.
The issue of pain is difficult, because it is not always quantifiable and is so different for each person and each situation. Yet in an end-of-life situation, the pain must be dealt with first before the person can have any hope of experiencing quality of life and saying goodbye to family and loved ones.
Q: This will be HFA’s 13th annual National Teleconference. You were the major force behind this program; can you talk about how it got started?
A: I was attending an NHPCO conference (back then it was NHO). I noticed that the program was devoted to critical issues affecting all areas of hospice care, yet most of the attendees were not the people that most needed that information. Many of the “hands-on”, in-the-trenches professions--the nurses, social workers, clergy members--were not in attendance, due to the difficulty in taking time away from their work and the money involved in attending an out of town conference. At that time satellite distance learning was becoming a more viable option, and we realized that this could be a powerful way to educate and support hospice professionals and others interested in end-of-life issues.
We continue to be proud of the growth of the teleconference audience. Although the program began primarily as a way to communicate vital information for professionals, the provision of Continuing Education credits (CEs) has become one of our ongoing obligations. For last year’s program, we had over 70 board approvals and gave out more than 24,000 hours of credit. We’ve also been pleased to watch as the teleconference has become a significant annual event in communities across the US and Canada, and how organizations utilize the program in creative ways to further their own outreach and networking on the local level.
