Dr. Robert Berkompas Brings Hope, Compassion to End-of-Life Care
Death is inevitable. That certain but often uncomfortable reality is the driving force behind the work of Robert Berkompas, MD, chief medical officer at Alive Hospice. A primary care provider for 25 years, Berkompas said the transition to full time hospice care seemed natural.
Care Throughout the Journey
"I chose primary care because I wanted to care for patients over their lifespan and for multiple generations," Berkompas said. "That includes understanding that you're walking with patients through the end of their life journey. That was part of my commitment going into medicine from the beginning, and I wanted to do it well."
After receiving his undergraduate degree from Calvin College in Grand Rapids, Mich., the California native attended University of Texas Southwestern Medical School in Dallas. In 1986 he arrived in Nashville for internal medicine residencies at Vanderbilt University Medical Center and Nashville General Hospital.
Berkompas soon began his primary care career at Saint Thomas Medical Group, a position he would hold until 2015. During this time he worked closely with Alive Hospice, which further peaked his interest in hospice and palliative care.
"On one hand you'd think it would be a natural progression," Berkompas said of the end-of-life role of physicians. "Still, more and more physicians are seen by patients as being there to fix and treat, without much understanding that it's really about healing, which is much broader than physical. In medicine there's a dichotomy that death has to be delayed at all cost, like it's optional."
Redefining End-of-Life Options
Today, Berkompas works with patients and providers to erase the stigma of end-of-life care. "All patients one day are going to die, and we need to recognize when it's imminent and help them focus on what's important during those last days," he said.
Those conversations are tough and often overlooked by medical schools amid the flurry of academic and technological training. To that end, Alive Hospice has developed their SHARE communication and training program (NMN, Sept. 27) to educate providers on how to have those difficult talks and to teach attendees to support families with honesty, autonomy, respect and empathy.
"Even though a physician might understand a patient is approaching the end, many find it difficult to address, and we want to provide guidance for that," Berkompas said.
Alive Hospice is currently working with medical students at Meharry Medical College and Vanderbilt. The program is also open to additional providers. Training is offered one-on-one or in a group setting and includes simulation labs with trained actors.
Palliative Care vs. Hospice
Berkompas also helps medical professionals understand the difference between palliative and hospice care and dispels misconceptions related to each. "All hospice care is palliative, while palliative care is addressing symptoms no matter what stage the patient is," he said.
Another misconception is the belief that hospice is only relevant in the last days, while it's often the most beneficial weeks or months in advance. Another erroneous belief is that Medicare patients can only receive hospice care for six months. In reality, hospice staff closely monitor and re-certify Medicare patients as necessary. Patients can keep their existing attending physician while in hospice care and can leave the program if it's determined to be in the patient's best interest.
Palliative care is beneficial whenever a patient has uncontrolled symptoms that keep them returning to the hospital. Diagnoses can range from lung or heart disease to rheumatoid arthritis. "Palliative care can be provided in an inpatient setting, but more and more we're providing this through outpatient clinics so care can be delivered in a home setting," Berkompas said.
Alive Hospice operates inpatient palliative care services at TriStar Summit Medical Center and TriStar Centennial Medical Center. Inpatient hospice services are available in Murfreesboro and Nashville. The innovative non-profit has also hired their own clinical pharmacist to address unique medication challenges faced by hospice patients, support clinical staff, and make home visits when necessary. Spanning 12 counties, Alive Hospice employs six physicians, five nurse practitioners and more than 300 employees to care for their 430 patients, the majority of which receive home care.
"I want to combat the idea that when you're nearing the end of life you give up all hope because there's a lot of living left to be done, and you have to maximize that," Berkompas said. "We want to emphasize that it's about living and not dying."