The Stories Behind the People Podcast: Dr. Christian Sinclair
The Stories Behind the People Podcast Episode 1: Host David Wensel, DO, FAAHPM, interviews Christian Sinclair, MD, FAAHPM about his career in hospice and palliative medicine and the development of Pallimed, the primer hospice and palliative medicine blog.
About the Host: Dr. David Wensel, DO, FAAHPM, began his journey into medicine by becoming a hospice volunteer after the death of his grandparents. Inspired by his volunteer work, he became a paramedic and later completed medical school at Des Moines University with a residency in North Iowa at Mercy Medical Center. He has been with not-for-profit healthcare provider Midland Care since 2010, and has been instrumental in the development of the Program of All-Inclusive Care for the Elderly (PACE) while working in hospice and palliative care programs. Dr. Wensel’s interests include medical ethics, palliative medicine and end-of-life care. He is known locally as a dynamic, passionate educator with a unique ability to make medical information accessible and interesting.
Intro music is “M&O Blues” recorded by Dorothy Kurtz, RN, BSN, CHPN and Greg Nelson, M.D.
Dr. Wensel: Okay, Christian, thank you so much for being here. Thank you for taking the time to do this with me, I’m just excited that you’re here! You know, you and I have a long history together. I consider you to be one of my mentors because you took me on as a student and sort of got me started in this process and I want to ask you if you wouldn’t mind telling your story about how you chose medicine, how you ended up in hospice, palliative care and how you ended up in Kansas City? How do you how did you end up here?
Dr. Sinclair: So, first of all, thank you for having me, it’s always good to work with you, and so I appreciate that. I graduated med school in 2000 from the University of California, San Diego. I’ve grown up in San Diego most of my life, although I’ve been living here in Kansas City since 2004, but was interested in medicine because at a young age, I was a burn victim from a bathtub scalding and have had several surgeries, over 20 surgeries on my legs, to help reduce scars and that sort of thing, so I was really intimate with the medical system from a very young age. So I had those ideals that I was going to be a burn surgeon, that sort of thing. I got to med school and I did a surgery rotation, and the first day on burns, I was like: “I can’t do this. This is not gonna work.”
Thankfully, I had a background in geriatrics from some of the anthropology work I did as my undergrad and appreciated geriatrics as the culture, you know, what is the culture of elderly people as a group? But also across different cultures. So I had done some volunteering at nursing homes before getting into med school and just really appreciated that patient population and their unique needs. So that drove me into internal medicine and a primary care practice. It was really looking at geriatrics and that was that Wake Forest in North Carolina.
Dr. Wensel: So how did you get from San Diego to Wake Forest? How did you make that leap?
Dr. Sinclair: My wife is also a physician, so we couples matched and pretty much lived our whole lives in California. We had just gotten married and we were looking to branch out, so most of the places we interviewed at were outside of California, because we wanted to go on a little adventure for four years. North Carolina was a good mix of outdoor options and a good, solid primary care program, which I liked. So that’s how we got to North Carolina.
There I was in a primary care track, so we had a lot more outpatient. Wake Forest has an excellent reputation for geriatrics training. There, I did a lot geriatrics was getting interested in it, but I found a unique area that really started to call to me, which was the ICU, and the ICU is not primary care!
Dr. Wensel: Not what you wanted!
Dr. Sinclair: The thing I realized I liked about the ICU was not… Although putting in lines and doing procedures is definitely intellectually very stimulating and being able to do aggressive medical care and see someone bounce back from that is professionally so rewarding, I enjoyed those aspects and I thought that’s what I liked about ICU, but I started to realize when I was doing night float rotations, and you’re just doing night after night after night, I started to realize there are lots of families who wanted to have conversations, and the attending wasn’t there, it was me, as the resident, to start to have these conversations. Families are asking “what’s going on? Can you sit down and talk to us for a little bit?” I would happen to have enough time or I’d make enough time to really have those conversations about what is happening, what we’re expecting. That led me to asking my attendings: “what is the prognosis for the patient? How do we know we’re doing good things that are going to help them improve as opposed to just getting them through this ICU day so they can get to tomorrow’s ICU day?”
Those types of questions really prompted them to push me towards the local hospice medical director who was interested in doing a palliative medicine fellowship. I didn’t know that there was extra training in these types of conversations, that there was a career you can make out of hospice or palliative care. So this is in 2003, and it was Dick Stevenson, I don’t know if you know Dick…
Dr. Wensel: I think I’ve met him.
Dr. Sinclair: Yeah, a great guy. Initially, he was in Maine and then in North Carolina and he was looking to start a volunteer fellowship. At that time hospice and palliative medicine as a training specialty was all volunteer, there were only a handful of training programs in the country, so they were all going by some voluntary guidelines of: “this is what we think a fellowship should look like…” and Dick, Dr. Stevenson, was very interested in doing that, and that sounded like a good fit for me with my interests. So I signed up for that.
Unfortunately, there wasn’t a fellowship in Kansas City. Like I said, there wasn’t a lot at that time, and our connection in Kansas City was that [my wife] Kelly got her pediatric emergency medicine fellowship in Kansas City, so we actually had to live apart for a year because there’s not a pediatric emergency medicine fellowship in North Carolina, and no palliative medicine fellowship in Kansas City, so we had to go where the training was. It was actually probably good we didn’t have kids, we just owned dog. It was good though, because it really allowed me to focus on my profession and my passion. The more training I did at the inpatient hospice house there in Winston-Salem, just drove that passion.
Dr. Wensel: How big was the hospice house?
Dr. Sinclair: It was [hesitates] ten beds at the time? No, it was 20 beds, actually, it was pretty big.
Dr. Wensel: Wow, it was pretty big for that time.
Dr. Sinclair: I think they had just expanded, maybe right before I joined, so as a fellow, I was pretty much running the inpatient unit while Dr. Stevenson was doing home visits. I was also doing home visits. There were not a lot of pediatric palliative care clinicians, and they have a strong pediatric program, so I was doing pediatric home visits as an internal medicine doctor, but the need for that specialty level of care was there. So there’s a lot of on-the-job training and a lot of learning from hospice nurses and phone calls to my wife, being a pediatrician…
Dr. Wensel: Great resource to have, by the way!
Dr. Sinclair: Excellent resource! So that was just a fantastic experience and a lot of recognition of the importance of inter-professional support. Respecting the nurses and the social workers, and really working with them and leaning on their expertise, especially since I was still learning so much of the field, they really were as much my faculty as any physician was. So that led to immense appreciation that I have from early part of my training. Nurses, social workers, chaplains, all have something definitely important to add to the care of a patient.
Dr. Wensel: So then the next step or the next question would be, so you finished your fellowship, how did you end up in Kansas City, and did you immediately go to work for Kansas City Hospice or how did that transition take place?
Dr. Sinclair: So my fellowship ended in the summer of 2004, and I was clearly looking for a job early in the spring of 2004 in Kansas City and there, KU had Dr. Porter Williamson, who had just come on after her fellowship, she was one year ahead of me in fellowship training. She had just come on to be the new director at KU, but didn’t have a program that was big enough to hire anybody. At Kansas City Hospice, their medical director, Dr. Ann Alegre, is well known in the Kansas City area for teaching so many people about good care at the end of life. Kansas City Hospice was one of the largest hospice providers, and they were looking to hire a full-time physician because they were already doing palliative care consults at Providence Medical Center, so they had not only a robust home hospice program, they had a palliative care consultative program in the hospital, and they were looking at potential in the future to open up an inpatient unit, because in 2004, the Kansas City, the metro, did not have any inpatient units. and so that was kind of on their three to four year plan. In 2006, they finally opened one up, and it was great because I was able to use my experience at the KP Reynolds Hospice House in Winston-Salem to help inform some of the real world, everyday issues that go on in the hospice house. You know, where the nurses are sitting compared to where the rooms are, and how that’s different than a nursing home or a hospital, so all those things. I was glad to bring some real-world experience to that process.
Dr. Wensel: And they have a beautiful facility.
Dr. Sinclair: Absolutely, beautiful facility, down at 120th and Wornall, and they have great staff there to fill out a beautiful facility.
Dr. Wensel: So how long did you stay with Kansas City Hospice?
Dr. Sinclair: I was with Kansas City Hospice from 2004 to 2011, and we had grown in that time. We had started a fellowship in conjunction with the University of Kansas, so Kansas City Hospice was the initial or the primary sponsor of partnering with an academic medical center to provide their opportunities. That was started in 2005-2006, so around the same time that inpatient unit was opening and we were expanding. We hired more medical directors, we opened up a palliative care clinic, we were doing a lot more in nursing homes, we started a home-based palliative care program, so a lot of growth and expansion in the area. It was nice to be able to be a part of building those programs and seeing them grow and realizing some of the big barriers to making them actually happen. That was until 2011, and at that time, I felt like I had exhausted a lot of my leadership opportunities. Kansas City Hospice was wonderful to give me those chances, but a new opportunity came about to make an impact on a more regional, national scale, which was when I took a job with Gentiva Hospice, which some people may know as Odyssey. Odyssey and Gentiva joined together and now Gentiva is part of Kindred…
Dr. Wensel: Oh, okay, I wasn’t even aware of all that…
Dr. Sinclair: Yeah. So I was with Gentiva up until became Kindred, about that time, so that’s about two years. But what was great about that was I was the national medical director, overseeing the Midwest and the Northeast hospice locations. I was meeting with seventy to eighty different hospice medical directors of around thirty to forty sites, and being able to see what hospices are like at different places, it’s very, very eye-opening. Recognize that when you are hospice medical director, you think about the quality of your own hospice, and the care that your team is able to provide. There’s always challenges and areas to improve, but you kind of think: “oh, I’m sure a lot of other houses are kind of like this.”
When you start to see thirty to forty different hospices, and many different hospice medical directors, some are very experienced, some who are coming in with very little hospice experience, you have a wider range of quality. I really appreciated that role because it was an educational role. I was talking to doctors who have a passion for a hospice but didn’t have, let’s say, a lot of background and training, and I was getting them up to speed on Medicare hospice rules which can be challenging at times.
So that was great to see what a hospice in Pittsburgh looks like is not always exactly the same as it is in Dayton or outside of Cleveland or going to Flint, Michigan. So I really enjoyed being able to travel then and meet lots of different hospice staff. The hospice executive directors at the site: really key to a successful hospice program. Basically, it started to come down, to me, to a rule, to say: the programs that really excelled and were able to not only provide quality, but make sure they were following all the many rules you have to follow, that is if you have a great executive director and you’re going to make sure that you’re hiring wonderful staff. If you have a great house medical director who really cares about the staff and the patients and the families, that’s who those two pieces. If you have those, I could almost always trust those programs. If there are other programs where they have a new hospice medical director or a new executive director, then I had to make sure that they had the knowledge to do the best that they could.
Dr. Wensel: It’s another one of the reasons why I wanted to have you on, because you have such a unique sort of perspective on all of this, not only from your background and experience, but even from the things that you’ve done on a national level with the American Academy of Hospice and Palliative Medicine (AAHPM). So listen, let’s now transition, and talk a little bit about how all of that started, because you’ve made such a tremendous impact, I think probably on all of us, really, but in terms of how you got started when you started with the American Academy of Hospice and Palliative Medicine and the roles that you’ve played in that organization, too.
Dr. Sinclair: So that probably goes back to fellowship so we’ll go back to North Carolina and 2003-2004. There weren’t a lot of fellowship programs around and I was a solo fellow, so as I’ve been training all by myself, I didn’t have any co-fellows to talk about you say others realize things or: “this is a really interesting situation that I came up against what do you think?” So without having that someone local and close it felt pretty lonely. And then of course it’s also lonely because my wife wasn’t there. Chad Farmer was one of my co-fellows at the time in Minnesota and he had started an email listserv, so a bunch of fellows, their program directors would eventually find out about this, or we’d find each other somehow, and we agreed this listserv, that was roughly associated with the Academy of Hospice and Palliative Medicine. I don’t know if it was official, is was semi-official, but anyway, the fellows would share challenging case truths, ask questions about, even like, salary for this volunteer fellowship and how many faculty members do you have and are you getting the training that you’re wanting.
So it’s really good to have that cohort of people. We met up at that year’s annual assembly in Phoenix and sat down and said: let’s let’s make sure that fellows are represented. We’re kind of voluntary fellows and we want to grow the field, so let’s make sure we have a forum with which to share the great things we’re doing and bring attention, shine a light on, challenges or problems that there may be out there. So at that meeting, a group of us got together and and we formed the professionals and training special interest group. That was in 2004 in Phoenix. They elected me chair, and that was great because I took that new mantle responsibility. At that time, the way you formed a special interest group wasn’t necessarily clear, it doesn’t have the formality that does have now, it was just, we got together and there were about 15 to 20 of us, and I still have the attendance list at home, and we just said: okay we’re forming.
I went up to Jim Cleary who was the newly elected president at the time, and I tapped, he was walking down the aisle at the time, on the back of the shoulder. I said: “Jim, I’m Christian Sinclair and I’m the new president or the new chair of the Professionals and Training Special Interest Group and you’re gonna hear a lot from the fellows. Now we we are together, or assembled, and we we have things to say and we have things we want to contribute to the field. So we now have a place and we want to be part of this academy.” He kind of said: “okay.”
So that was great and so that was in 2004. We did we did work at the academy and still have come down to the email list but things didn’t change, probably, until 2005, when I stumbled across a website by Drew Rosieal, called Pallimed. Drew Rozelle was a third year resident at the time. It was in May or June of 2005, and he recognized he’s going into a palliative care fellowship and said: “hey I’m reading the articles, and I want to, when I’m reading about them, I’m just gonna type up a few notes about them and post them on this blog.”
So in 2005, blogs were pretty popular, growing out of lots of different industries but there weren’t a lot of medically-focused blogs. They were starting to come into fashion at that time, and me being a technophile I stumbled across it on a one day and said: “oh my gosh this guy’s so smart, brilliant, witty and he’s finding stuff that I’m not finding. You know, he’s finding this in journals of gastroenterology, I don’t read that. I’m not going to search for that on PubMed!” And so I started commenting on it and then and then eventually started commenting so much I said: “can I write with you? Like, can we write together?” And this was all through email, never conversation, and he said: “sure, okay, why not?”
And so we both started writing together, and amazingly, we started looking at the views, and the views started going up. Like the views were like, 10 per day or like, 20 per day, not a lot of people, and we started getting feedback like: “oh, this is really interesting or this is helpful” or people saying: “hey, I shared this with my hospice team.” We started to recognize, oh, maybe this is having a bigger impact than we thought, and from that, just putting our opinions out there, hopefully informed opinions, it started to get both of us more name recognition. We weren’t pulling down huge research grants. I spoke occasionally at academy conferences, but it wasn’t like I was the best speaker or anything like that, so didn’t have big education credentials behind my name, but it is through social media and just writing down our opinions that, at the least the views and the feedback we were getting was saying this is something quality, that people were getting some benefit out of.
We started working on getting more writers. Pallimed now, 12 years later, we have we’re about to cross the 4 million page view mark. We have had, over the 12 years, we’ve had almost over a hundred writers contribute to the website.
Dr. Wensel: Which is awesome.
Dr. Sinclair: It’s an all-volunteer project, but it’s been really fantastic, and because of that I started realizing, maybe I have some opportunities to do some leadership. I was already doing some minor conference work for the American Academy of Hospice and Palliative Medicine, but I decided to run for the board. I wasn’t exactly sure what you did on the board, but I knew from saying that the fellows need a voice, I want to be a young person on the board. I wanted to bring that voice of the fellows, and I figured I had maybe enough credentials from Pallimed to say I’m not dumb, at least.
Dr. Wensel: One thing I want us to make sure we capture here and say about Pallimed, too, is when you say you’ve had over 100 writers, guest writers, the writing quality is top-notch.
Dr. Sinclair: There’s some good writers on there.
Dr. Wensel: I mean, it could be a journal, and in and of itself, really.
Dr. Sinclair: Right! So people like Lizzy Miles, who’s a social worker in Ohio, Emily Regal is a pediatric and adult medicine palliative care doctor here in Kansas City, and Lyle Fettig… There’s some are some really, really quality writers. And there’s a few that I’ve actually turned away and said, these need to be submitted to JAMA or pediatrics, and there have been pieces that have been published other places that were initially submitted to Pallimed.
Dr. Wensel: I just wanted make sure we got that in there, it’s top-notch.
Dr. Sinclair: I do want to say I sometimes get the feeling that people come up to me and think that Pallimed… So in around 2010 Drew stepped down from being the editor and I stepped into the editor position, but sometimes people come up to me and say, oh, it’s Christian Sinclair, that equals Pallimed, but I want I definitely want people to know there are multiple volunteers, I want to give a shout out to a couple: Lizzie Miles, Meghan Mooney, Meredith McMartin, they have all done really, really great work to help make Pallimed and the other social media brands or efforts under the Pallimed umbrella. It’s a volunteer effort, it’s a team effort. They may not get the attention or press but they definitely make it happen.
Dr. Wensel: Good, I’m glad you could do that!
Dr. Sinclair: Gotta give the credit to them, and we’re always looking for more volunteers! So if you’re a hospice or palliative medicine clinician and you have something to write we’d always love to have it.
Dr. Wensel: Excellent! So then you ran for the board of the American Academy of Hospice and Palliative Medicine in…
Dr. Sinclair: 2007, and I didn’t make it.
Dr. Wensel: And that’s okay, so then what happened?
Dr. Sinclair: So then I ran again!
Dr. Wensel: Yeah, you don’t give up!
Dr. Sinclair: Yeah you gotta stand back up. So in 2008 I was elected then, and so I started serving on the board in 2009. So that’s been a great experience. What’s been really interesting is with Pallimed, I have my ear to the ground, I feel like I know a lot about what’s going on in the fields of hospice and palliative care, just with the attention of social media and journals, and that sort of thing. When I got on the board, it was a whole other level, oh my gosh, there’s a whole lot more stuff going on than I was really aware of. Serving on the board really deepened my love for the Academy. It does a lot of work on a very efficient budget. So the amazing areas… the breadth areas of they’re able to cover has always been impressive to me.
Dr. Wensel: And I don’t think people really know all the areas that they actually cover. I sometimes wish we had a way, and I’m going to have Steve Smith on so we can talk about that, because I think that is a message that a lot of people don’t know. Of just how amazing, on a what budget this is being done on, and it’s really incredible, the areas that they reach into.
Dr. Sinclair: Yeah, right, and one of the things, I went in saying, I need to be a voice for early career professionals, and fellows and recognizing that, you know there’s so much work to do in advocacy, and partnering with NHCPO on hospice issues, and then working on legislative issues and becoming regulatory partner with the AMA on all the different things that can come into the house of delegates from different states, and making sure that they are keeping hospice and palliative care clinical situations in mind, because sometimes, that’s not always the case. It’s been wonderful to see what the Academy has done in what our field is doing. And that, again, speaking of volunteer leaders, there’s definitely paid staff with the Academy, but there’s a lot of volunteer leaders who are doing fantastic things, and they don’t always get the recognition, but I think that it is important to realize they are helping all of us who are in this field and not just physicians, making sure that we have an easier way to take care of our patients in a safe setting.
Dr. Wensel: They provide a voice. I always see them as our voice in those settings. You’re a hundred percent right, and even though all the stuff that you’ve done, all of that volunteering, out of the out of your love for the discipline, and all these things. So on the board, when did you take over as the president? You’re coming off your last term now?
Dr. Sinclair: Yeah, I only have four more months, five more months now, March is when I’m off the executive committee because I was elected as president and served as president from 2016 to 2017, so up until February of this year, and and again, there’s a different level of knowledge. Like, once you go from a member in leadership positions in the Academy to the board you say, oh my gosh there’s so much more stuff and then you get to the presidential level, and I was having weekly calls with Steve Smith, who’s the executive director and CEO of the academy, and all the different things that were in place. …