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Although much of his career has focused on end-of-life care, David Tribble, MD, has always embraced new beginnings. As the recently-named chief medical officer and vice president for medical services at Nashville's Alive Hospice, he will continue to look for innovative and effective ways to help the patients he serves.

For the past 16 of his 32 years in medicine, Tribble has been committed to ensuring that compassionate care is available to those facing life-threatening illnesses.

This career choice had an "unfortunate" beginning when he was almost dismissed from a training program as a result of a disagreement with the attending physician who refused to tell his patient – a 54-year-old nurse anesthetist – that she had an inoperable condition because the doctor felt that with the information, she would "be too upset to fight."

"But," Tribble said, "she figured out what he refused to tell her."

Tribble continued, "I gulped, and then made a personal decision to tell her the truth about her condition, overstepping myself horribly. Luckily, I was not expelled from the program because more temperate minds prevailed. From that patient onward, I have felt that patients should be treated honestly and openly."

A native of Sacramento, Calif., Tribble served as a general medical officer in the United States Air Force after he graduated from medical school at Temple University in Philadelphia. He began his hospice work in 1982 and came to Nashville in September 2008 from the Center for Hospice and Palliative Care in South Bend, Ind.

"I only came to Nashville for the position. I had heard of the music industry and been here two or three times," Tribble said, "but until I moved here, I just wasn't aware of the richness of Nashville."

In his new position, he supervises care for patients in the 30 beds at the Alive Hospice Residence Nashville, 16 beds at Alive Hospice at St. Thomas Hospital, and 16 beds at Alive Hospice at Skyline Madison Campus, plus at other area hospitals, long term care, assisted living and independent living facilities. Alive Hospice cares for roughly 440 Middle Tennessee patients each day.

Tribble directs the interdisciplinary team of physicians, nurses, social workers, certified nurse technicians, chaplains and volunteers who cover all aspects of patient care.

A member of the National Council of Hospice and Palliative Professionals and the American Academy of Hospice and Palliative Medicine, Tribble has been published in the Journal of Clinical Therapeutics and is a fellow of the American Academy of Family Physicians.

Since he has been at Alive Hospice, Tribble has been impressed by the professional care offered to people with life-threatening illnesses and the support shown to their families.

"When I was training, there was a different mind set." Tribble recalled. "Death was considered a medical failure, and in many traditional medical settings, the phrase 'lost their fight' somehow implied that the will of the patient wasn't strong enough," he said.

"I learned two things in my training," he added, "that the First Rule is 'Everybody Dies,' and the Second Rule is 'Doctors Can't Change Rule #1.' There is an art to knowing when we're at a point where further treatments mean more pain than more help.

"At that point," Tribble continued, "we need to give the patient good information to help him make the decision about further treatment."

He explained, "The palliative care that Alive Hospice administers is 'comfort directed' as opposed to 'treatment directed,'" and he is convinced "the patient deserves a direct answer and to hear the truth without being robbed of hope."

Under the Medicare hospice benefit, patients who face life-threatening illness and a projected life expectancy of six months or less are eligible for hospice care. Tribble said hospice is the most rapidly growing part of the federal Medicare budget... in part because patients are often involved with a hospice program for a longer time period than six months and in part because a growing number of patients are becoming involved.

"If you start doing the right thing, costs go up because you will be doing it for more people, which is why there is such huge growth," he said.

Alive Hospice "has made a commitment never to turn down a patient based on ability to pay and offers a number of opportunities for charitable donations and grants to continue treatment when other help is not available," Tribble said, adding the local organization is very well respected on the national stage.

There are more than 22 different hospice agencies across the country providing the type of care that Alive Hospice does in the 12 counties of Middle Tennessee. The first hospice in the United States was formed in Connecticut in 1974, closely followed by Alive Hospice in Nashville, which was founded by David Barton, MD, and John Flexner, MD, in 1975.

Always eager to find new ways to improve service to patients, Tribble is excited about new research opportunities that Alive is opening up, especially opportunities with Vanderbilt Hospital patients for research on developing best practices in dealing with pain and nausea at the end of life.

"The research is very carefully monitored to be sure we're guarding the rights of patients," Tribble said. Characteristically, he admitted, "There is always room to sharpen our skills to provide better care."

Tribble is married and step-grandfather to seven youngsters. He plays the piano for relaxation and enjoys photography and woodworking — cabinets and furniture are his specialty. However, his real woodworking claim to fame is a unique "rocking motorcycle" that he crafted for one of his grandchildren. He also admits that, on top of family and work responsibilities, a one-year-old Great Dane puppy "takes a lot of my time."

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Alive Hospice, David Tribble

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