A Way to Bring End-of-Life Care to Remote Communities

Under ordinary circumstances, a doctor would not really want to be able to say that an estimated 1,000-2,000 patients had died under his care. But that’s not the case for palliative care physicians like Doctor Michael Fratkin, who specialize in end-of-life care for people dealing with terminal illnesses. Their goal is to help patients, and their families, come to terms with death and facilitate an experience that will be healing and rewarding, rather than traumatic.

Many Americans want to die at home and make their own choices about treatments and interventions at or around the time of their deaths, but instead, they’re forced into hospitals and obligated to endure a series of uncomfortable and sometimes upsetting treatments designed to prolong their lives, rather than improve the quality of their final days.

Palliative care internists like Dr. Fratkin take a different approach. They want their patients to be comfortable and supported, and they want to integrate families and friends into the final days and hours of their patients; where other doctors might focus on keeping the patient alive for as long as possible, palliative care physicians are more interested in responding to feedback from their patients. Their focus may be on analgesia and other measures to improve comfort, such as prescribing antibiotics for infections and teaching family members how to care for patients to help them avoid bedsores and other complications. Or it could be on helping patients make decisions about the treatments they want to pursue, and at what point they want to stop treatment. They offer advice and support without assuming that the goal of care is to live as long as possible or cure a condition.

Such services are available to a growing number of patients in urban areas, where there are enough patients to support palliative care practices. People interested in end-of-life care can discuss options with their primary care physicians and other specialists to decide whether they want a referral, and they can work to develop a care plan that meets their needs and desires. In rural areas, however, this is a lot harder. Full-time palliative care specialists, like those needed to provide ongoing support to dying patients, aren’t able to find enough work in rural communities because of the limited number of patients at any given time. Such regions are also remote, and patients are often far-flung and difficult to access.

That’s where Dr. Fratkin and his crowdfunded program, ResolutionCare, come in. Concerned by the limited options for people living in rural and remote communities, he was inspired by remote medicine programs like Project ECHO, an initiative at the University of New Mexico that specifically targeted rural hepatitis C patients who weren’t receiving adequate care. For patients who wish to remain at home rather than being hospitalized, their team offers house calls, virtual house calls and holistic support that revolves around compassionate treatment of patients as part of a network and community, rather than as bodies to be fixed.

His work isn’t limited to the communities he works with, and people will be able to access his telemedicine services anywhere in California. He’s also trying to provide a model for similar palliative care initiatives across the country, addressing what he sees as a critical missing component of health care in America. In a country focused on making people better, sometimes we forget the value and importance of letting people go — and that’s what his profession is all about. His program focuses on quality of life, and if it also extends the days or weeks someone has to spend with friends and family, that’s an amazing additional benefit.

By making palliative care accessible and affordable, Dr. Fratkin hopes to empower patients to make their own choices about death and dying, and to help patients control pain, fear and discomfort as they deal with terminal diagnoses. The growing profession of palliative care relies on innovative specialists like him, who are determined to disrupt the future of medicine — and it’s a mounting issue in a country with an aging population.

Photo credit: Lee Haywood


Naomi Dreyer
Naomi Dreyer3 years ago

I like the idea of Pallative Care. As for death - we Baha'is believe that after its association with the body draws to a close, the soul will continue to progress in an eternal journey towards perfection. www.bahai.org

Siyus Copetallus
Siyus C4 years ago

Thank you for sharing.

Bonnie Bowen
Bonnie Bowen4 years ago


luna starr
luna starr4 years ago

people especially sick ones have rights

Kamia T.
Kamia T4 years ago

One thing I will credit about the medical establishment here is that there is a very strong in-home hospice care program. It just makes economic sense! Why spend $2,000 a day for someone to be in nursing care, when they can accomplish the same thing at home, and be happier at the end of their life?

Joan E.
Joan E4 years ago

This is important and caring work that not everyone is willing or able to do. Thanks to those who can and do.

Muff-Anne York-Haley

This is a wonderful approach for an aging population:)

Elizabeth F.
Elizabeth F4 years ago

Love your comment T.

Deborah M.
Deborah M.4 years ago

We need more people involved in Palliative Care. As someone living in the UK where they are considering euthanasia and as a supporter of euthanasia in a society where as the article said the intention is to be able to make you live longer I would be happier to change my mind if I knew that Palliative Care was in place with someone who could get to know me in my good times and bad. That would make all the difference as compared to hospitals where the waiting time is often over 4 hours and nurses don't have time to get to know their patients properly.

Janet B.
Janet B4 years ago