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“Doctors Need To Take The Time To Learn What Is Most Important To Their Patients” With Dr. Bob Uslander

I had the pleasure of interviewing Dr. Bob Uslander, the founder of Integrated MD Care, a new model of holistic, individualized, in-home…


I had the pleasure of interviewing Dr. Bob Uslander, the founder of Integrated MD Care, a new model of holistic, individualized, in-home medical care for people with serious and terminal illnesses. 
 
Dr. Bob is on a mission to eradicate the fear and struggle people so often encounter when they’re facing a serious or terminal illness, so they can live with comfort and joy and die with peace and dignity.

As a physician for more than 30 years- initially as an emergency physician and more recently as a palliative care and end of life specialist, he bears witness every day to the despair and devastation caused by the gaping holes in our healthcare system. Dr. Bob is a passionate advocate for his patients and is leading a movement to empower people to live better and die better.

Dr. Bob speaks honestly and openly about what he believes is a “human rights violation” being perpetrated on people throughout the country. It’s not simply a matter of “have” or “have-not”. These are deeply embedded systemic problems that impact people of all demographics and all financial strata. These issues are known to those within the system, but they are not exposed to the outside world, so people don’t become aware of them until it’s too late- until they are directly being impacted by them, directly in the line of fire.

Dr. Bob leads a team of medical providers and integrative therapists who are dedicated to empowering people to live with joy and die with dignity. Through this innovative model of care, Dr. Bob is helping to transform the way people live and die.

Since the California End of Life Option Act became effective in June, 2016 Dr. Bob has been supporting patients with terminal illnesses through Medical Aid in Dying. He and his Practice Director/Social Worker, Elizabeth Semenova, have become compassionate experts in guiding patients and families through the Aid in Dying process, allowing them to have the most peaceful and dignified end of life experience possible.


Thank you so much for joining us! Can you tell us a story about what brought you to this specific career path?

Sure. There are a couple I can share actually. The first took place 17 years ago, almost to the day. I was 10 years into my career as an emergency physician when a good friend of mine became ill and then died from melanoma. Darren was 32, with a wife and three boys under the age of 5. He was a strong, athletic, fun-loving guy who developed a really bad disease and died way before he should have.

I was his friend and became his doctor as well because he didn’t have a doctor- he’d been perfectly healthy. At first he needed very little from me. We just got to hang out more and be friends. As his health declined, we decided to reach out to the local hospice folks in the small town I was living in at the time. I’d never had any exposure to hospice, so wasn’t sure what to expect. I was blown away by the incredible care that hospice team provided. I’d never seen anything like it. I was with Darren and a small group of friends and family through the last days of his life. On his final day, I sat nearby as he took each of his little boys on his lap one by one, hugged each one and told them he loved them, and then said goodbye. Then, at his request, I gave him a bit of medication through an IV that allowed him to relax and sleep. The following morning, as we sat beside him, he gently took his last breath. That was September 14, 2001, three days after the 9/11 tragedy. That entire experience planted a seed for me. There was a depth of connection and a sense of purpose I’d never felt before.

But life kept happening and it was more than ten years for the seed to germinate and break through the surface.
 
 In 2013 my family and I had moved from northern California to San Diego in search of a more meaningful and sustainable career path. I was feeling the strain of more than 20 years as an emergency physician. I wanted to do something that would be less stressful (physically and emotionally) and would have more impact on the world. I had started doing some life coaching for other physicians to help them find more passion and purpose in life, yet I was struggling to find my own passion and purpose at that point.
 
 One evening I was at a party for a friend’s daughter in La Jolla, California, and was sitting in contemplation on a bluff overlooking the Pacific Ocean. Suddenly and without warning, my body start tingling and I became super alert and energized. Then I felt, and heard, the words “You are here to help people die.” I didn’t know what to make of it, and I didn’t mention it to anyone. I just went on as if nothing had happened, but things felt different somehow.

The next day a friend invited me and my son to go with his family to a festival at a nearby park. As I was leaving the festival several hours later, I passed by a vendor booth and made eye contact with the woman standing behind the table. I looked behind her and saw a banner indicating the booth was for a local hospice and palliative care company. We struck up a conversation, a friendship began, and a few months later I was the Medical Director for a new palliative care practice. That was my introduction to the world of palliative care and hospice, and is what ultimately led me to the work I do now, which is helping people have the most peaceful and beautiful death, and the most joyful and comfortable life leading up to it.


How have your personal challenges informed your career path?

Both of my parents died from lung cancer in the past few years. It’s been 3 years for my dad and 4 years for my mom. My dad would have been 85 yesterday.

My mother had lung cancer when she was around 70. She had surgery to remove a portion of her lung, followed by chemotherapy and radiation, which she tolerated well. She did ok for almost 10 years, and then it came back and came back fast and hard. She was gone in a few weeks, and it was a pretty rocky few weeks. I had transitioned to being a palliative care doctor a few months before that, so I’m sure I was able to ease things some, but she still struggled more than she should have at the very end. I still have angst about what she had to endure, and I know that many people are forced to endure far worse.
 
 Eight months later, out of the blue, my dad was diagnosed with stage 4 lung cancer. He was just coming out from being in a funk after losing his mate of 59 years, but was working full time (running a small homecare company) and was enjoying being a grandfather to my 8 year old son. He had a little cough one day, and the next day he had terminal cancer. He was practical and accepting, and determined to fulfill one of his great wishes- a three-week trip through Thailand, Vietnam and Cambodia with my older son, who was twenty three and the time. He made the trip, and came home and died two weeks later. It was a quick, painless, peaceful death. He did it on his own terms.

I decided that I could prevent people from dying after a significant struggle, like my mom did, and make sure more people could die like my father did.

So a few months later I started my own practice, inspired by my mission and clear about my purpose. It’s been an amazing journey from day one.


Can you share five pieces of advice to other doctors/clinicians/healers to help their patients to thrive?
 
 After caring for hundreds, perhaps thousands, of patients facing complex health issues, including terminal conditions, I recognized that I follow a very similar process in almost every instance. This process allows me to partner with my patients and families to co-create a plan that empowers them with clarity and direction, which reduces their fear and increases their peace of mind. 
 
 I think my process could help other physicians and clinicians engage with and support patients under their care. I call it The RIGHT Formula for Empowered Living and Dying.

  1. Patients and families need to understand the REALITY of their circumstances, so they can make the best, most informed decisions. This includes the reality of their health condition, the reality of their expected prognosis, the most likely outcomes and effects of any treatments they may agree to, and the reality of what the health care system will and will not provide for them. Too often, patients and families are only given bits and pieces of information, and they end up making decisions based on incomplete information, or false information.
  2. Doctors need to take the time to learn what is most IMPORTANT to their patients. What do they value most? Is it their family? Their independence? Their hair? Their intellectual capabilities? Unless we know what is influencing our patient’s decisions, we can’t help them make decisions that are most aligned with their values and wishes.
  3. What are the GOALS of the patient and family? Once we understand the reality of the situation and what is most important to them, we can help them arrive at some meaningful and achievable goals. These can be a combination of long-term and short-term goals that can give the patient and family more purpose and incentive.
  4. Develop a plan for what needs to HAPPEN. People with a serious or terminal illness usually like to understand what is happening and feel like they have some control over their circumstances. Illness often robs people of the sense of control. The first four steps of this formula can empower them and reduce their fear and sense of struggle.
  5. Identify who is on, and who is at the helm, of the TEAM. People with serious and terminal illnesses need guidance and support, as do their families. It is critical to have some structure and to have a quarterback to coordinate the process. The teams can include someone able to advocate, someone willing to make phone calls and manage the schedule, etc.

Social media and reality TV create a venue for people to share their personal stories. Do you think more transparency about your personal story can help or harm your field of work? Can you explain?

I think it can help. The stories of the people and experiences that influenced me along the way and brought me to the place I am now makes me seem more real and trustworthy to prospective patients and loved ones. I think transparency is important for medical providers.

Can you please give us your favorite “Life Lesson Quote”? Do you have a story about how that was relevant to your life?

“It is what it is.” This phrase was uttered by my father on a regular basis during his final months of life. He was diagnosed with stage 4 lung cancer 8 months after his wife, my mother, died from the same disease. He appeared to be in excellent health and was fully engaged in life- working full-time at the age of 80 and spending quality time with his family, when he was diagnosed out of the blue.
 
 He was an engineer and a very pragmatic person. He knew what he was facing and he did not want to waste time with futile and debilitating treatments. “It is what it is” was his mantra. Not to be pitied. Not to be a victim. 
 
 He was able to fulfill one of his life’s dreams by accompanying his oldest grandson (my son) on a 3-week trip through Thailand, Vietnam and Cambodia, and died peacefully and with dignity exactly 2 weeks after returning.


You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂

I am passionate about helping people everywhere develop a more comfortable relationship with death. Being comfortable with the concept of death, becoming “friends” with death, can make life richer and more meaningful, by reducing a major source of fear and anxiety. This is true for the public as well as for the medical community. It doesn’t help for people to get more comfortable talking about death if their doctors aren’t equally comfortable.

My work also involves educating people about the options available to them when they are living with a serious illness or dying. Our healthcare system is so protective and secretive about all the gaps and problems that people are unaware of them until they are in a desperate situation and struggling to understand what’s happening and what they can do about it.

Far too many of the most vulnerable members of our society are being shuttled through the system, kept uninformed, and left to figure things out on their own. They’re hospitalized for weeks or months, churned up in a system that has no disincentive to stop.

Instead of being empowered to live with joy and purpose through all stages of illness and death, people are fearful and frustrated- disappointed over and over by their experiences, but without any understanding of how to make things better.

I see this as a Human Rights Violation of epidemic proportions, and we need to put an end to it.

How can our readers follow you on social media?

My website is www.integratedMDcare.com

My FB page is www.Facebook.com/DrBobUslander

Originally published at medium.com

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