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Doctor Q&A: Michael Rabow

A pivotal experience during medical training helped Dr. Michael Rabow realize what he cared about most: helping patients with serious illnesses live as well as possible. He joined the emerging field of palliative care and is now director of the Symptom Management Service at the UCSF Helen Diller Family Comprehensive Cancer Center.

Tell us about your job. What does a Symptom Management Service director do?

At the core, what I do is entirely focused on helping improve people's quality of life, both by treating their symptoms but also by making sure their care is consistent with their preferences. And when patients get to the end of their lives, we also help make sure that their quality of life is as good as it can be for as long as possible.

What made you want to go into this deeply emotional line of work?

I think it comes from basic humanity — just caring about the suffering of someone else.

I think almost everyone involved in health care has that motivation but people do different things to express it. Some people are doing pure science research, other people are doing administrative work and others are doing clinical work.

Early on it became clear to me that helping people make the best use of the time that they have was what matters to me the most. It's the most fulfilling work that I can do.

Was there a moment during your education that made this clear to you?

There was. It was during the third year of my residency in internal medicine. I was on call and I was summoned around 3 a.m. to go see a patient. I saw a man sitting on the edge of his bed, with his head in his hands, clearly upset. His distress, and helping him get through the night, was what really mattered to me. It just so happened that the field of palliative care really came about at that time.

How did the field of palliative care come about?

In the U.S., palliative care formally began in the late '80s. It really began as end-of-life care, focused on people at the very brink of death. But we soon realized that palliation isn't just for people who are at the end of life — it makes sense for everybody who is suffering from their disease or from the treatment of their disease.

Why is palliative care now such a crucial part of our medical system?

Without palliative care, people would experience more pain, but also more depression, anxiety, shortness of breath, nausea and insomnia. Without palliative care, we'd be taking away one of the fundamental tenets of medicine: to cure often but to try to relieve suffering always.

I think every physician, nurse, social worker, chaplain and pharmacist should have some understanding of the basics of addressing patient distress. There just aren’t that many palliative care specialists to take care of all the need out in the world.

What makes you smile even on tough days?

Every day I see patients who are facing their worst fears, the hardest experience of their lives, and many of them are growing from it. It's a beautiful thing to see. That's a lot of what inspires me and keeps me going. I'll never tire of seeing someone be brave, face their fear. I'll never tire of someone who asks me how I'm doing while they're the one who's having all the obvious challenges of their disease.

Plus, I love the people I work with. I love being connected with people who care about the same things that I care about.

How does palliative care help families as well as patients?

The first thing we offer to many families is just a deep, deep recognition of what they're doing on their own to care for their loved one. It's rare that I compliment a family caregiver about the work they've done without having them break into tears, often because they feel so guilty about what they haven't done.

As a health care system we actually offer very little to families but demand so much of them.