New medical director at Hospice & Palliative Care Buffalo talks about new position, challenges and what it takes to be a doctor treating end-of-life patients
By Chris Motola
Q: You recently became the head of your facility.
A: I’m the medical director of Hospice Buffalo as of January of this year.
Q: What path led you to that position?
A: I’ve been at Hospice Buffalo for about 11-and-a-half years. Initially I was a part-time physician, but I’ve been full-time for quite a while. I’ve been an attending physician in our inpatient unit. I have, over the years, done palliative care consults in hospitals and a little bit of home care. So I’ve been here for awhile and been involved in a lot of the different patient care areas and also in the education efforts and research.
Q: Did you seek out a leadership role?
A: It was offered to me. The previous medical director was cutting back on her hours and stepping away from the position. Over the last year I’d become very involved in our COVID policies and infection control. I’ve been working closely with several members of our leadership team. They approached me to see if I’d be interested in assuming the medical director position and I was.
Q: What challenges were there jumping into this role while under pressures from COVID-19?
A: There’ve been ongoing issues with everything related to COVID whether it’s been trying to get adequate PPE [personal protective equipment], making sure our policies regarding patient care and staff are in line with the CDC and state of New York policies, which are constantly changing. So there have been a lot of efforts there. We’re also continuously updating our formal infection control policies to match new information as it comes out.
Q: Given how vulnerable hospice and palliative care patients are, what special considerations have they needed during this time?
A: Our patients are very medically compromised. Nearly all of them are at a high risk of suffering complications from COVID or the flu or any other illness. We’ve erred on the side of being conservative with the use of PPE as well as policies regarding staff quarantining and isolating even when there isn’t a positive test but there’s a strong suspicion someone might have COVID or COVID-like symptoms. We try to be very, very careful to limit exposure for patients and their family members since the family members may in many cases be elderly or medically compromised as well.
Q: My impression in recent years is that there’s been a push toward a focus on quality of life over quantity of life when it comes to end-of-life care. How do you keep that mission in mind during a crisis like COVID-19, which is having an extremely negative effect on many people’s quality of life?
A: That’s been a challenge as well. We’ve never had to completely limit visits the way they have in nursing homes. We’ve been able to allow visiting, but we’ve had a decrease in number of visitors at a time and in visiting hours. We feel it’s so vitally important for patients and family to have time together. We’ve worked very hard to keep that going in a safe way for patients, family and our staff. We have also at times been the place where families have been reunited with their loved ones after a prolonged hospitalization or a nursing home stay. Our interdisciplinary provides a lot of psycho-social support for patients and their families, because it’s been very difficult for everyone over the past year—just the isolation for the patients and lack of access for the families. We also have a bereavement team that remains in contact with families for up to 13 months after their loved one passes, so we provide support there. We also have social workers, chaplains and expressive therapies department that provide support for patients and their families.
Q: Do these policies differ between the hospice and palliative care side of things?
A: In terms of COVID? No. In a lot of ways the patients are similar or have similar medical issues. The main difference between hospice and palliative care is often whether the patients are still pursuing aggressive care. But they may still be elderly or have advanced illness in palliative as well. So we have applied the same policies to both sides of our operations here.
Q: What kind of impact do you want to have as medical director?
A: As always we want to provide the best possible care for our patients and support for their families. I’m trying to work hard to maintain the communication between all of our departments. I hope that I’m approachable and able to respond to any concerns anyone has. We’re working hard to support our staff because it’s been a very challenging year. We’re sort of in a continual process of hiring. So we’re continuing to try to fill vacancies and allocate staff to where they’re needed most.
Q: Are you still practicing?
A: I am still one of the attending physicians in the inpatient unit, so I see patients in the inpatient unit every day in addition to the more administrative parts of my job. I’m also heavily involved in our education activities. To me that’s a very important part of my job, providing education to other medical professionals.
Q: How would you pitch hospice and palliative care to a prospective physician?
A: It takes the right kind of person, the right kind of personality. You have to be suited to it. I often explain palliative care and hospice care as being a different viewpoint. We’re practicing the same medicine, using the same medications, treating the same diseases and disease processes. We’re looking at the patient, their goals, their symptoms and their quality of life. I’m not treating an illness or strictly following guidelines because they no longer really apply when someone is in their last months of life. This is a specialty where we spend a lot of time with the families of patients as well as the patients themselves. So it requires someone who enjoys the communication aspects of medicine. It’s a very rewarding specialty and one that I think more medical students are becoming aware of even though there isn’t a lot of training for it in medical school. It’s usually something they encounter afterwards.
Name: Debra Luczkiewicz, M.D.
Position: Medical director at Hospice & Palliative Care Buffalo
Hometown: St. Louis, Missouri.
Education: SUNY Buffalo School of Medicine
Affiliations: Hospice & Palliative Care Buffalo
Organizations: American Academy of Family Practice; Academy of Hospice and Palliative Medicine
Family: Husband (Ken), two children
Hobbies: Sourdough baking; reading; gardening