Dr. Matthew Tyler returns to explore the layers of palliative care — what it is, what it isn’t, and how it differs from hospice. We discuss everything from managing physical and existential pain to the role of family dynamics and coping skills in end-of-life care. Is pain at the end of life inevitable, and how can it be managed? What role can patients and families play in guiding medical decisions at the end of life? How can families and caregivers better cope with the complexities of serious illness? Whether you’re supporting a loved one or navigating illness yourself, this conversation offers practical insight and hope. Dr. Tyler also introduces his new caregiver coaching services, designed to help families find clarity and confidence in uncertain times, especially when local palliative care is not available.

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Transcript:

Diane Hullet: Hi, I am Diane Hullet and you’re listening to the Best Life Best Death podcast. And today I’ve got a terrific guest that I’ve had on before, Dr. Matthew Tyler, and you and I spoke previously on Best Life, best Death, number 1 28 and number 1 64. And I’m excited to be talking again for a double episode.

’cause I just think you bring so much to the conversation. 

Dr Matthew Tyler: Well, thanks for having me back. It’s good to be here as always. 

Diane Hullet: So for folks who haven’t heard you before, give us just, you know, the elevator speech of who you are and how you came into the work you do. 

Dr Matthew Tyler: Sure. So, uh, I, uh, mats, I’m a hospice and palliative medicine doctor.

Uh, but by and large I practice palliative medicine in the hospital and clinic setting. And for those of you who are unfamiliar with palliative medicine and what that’s all about, palliative medicine provides support to anyone dealing with a serious illness like. Cancer, heart failure, dementia, and our focus is on anything that’s important to your quality of life with the really important distinction that you can receive palliative care alongside all those other treatments like chemotherapy, heart failure treatments, uh, so a distinct entity from hospice care.

And, uh, a large part of what I do in my online persona, how to train your doctor is teaching people about palliative care, what it is and what it’s not, and how it’s different from hospice. So that way when you are facing a serious illness, you know when and how to advocate to your medical team for all the support that you deserve.

Diane Hullet: Well, and I think it’s worth underscoring that ’cause, um, as, as Matt said, it’s, it’s how to train your doctor, which I just think is a fabulous title. And he’s on Instagram and Facebook and YouTube and all the places. And you can, you can watch these incredible little short videos where you, um, play out different scenarios and, and kind of, uh, role play.

Ways that you can talk or ways that your doctor might talk and just give you ideas about how to train your doctor so that you can have a good working relationship. Because it seems like that’s what it’s really about. It’s, it’s a working relationship, not that your doctor is just, um, the, you know, God from on high telling you what to do or not do.

You’ve gotta. Understand that relationship and feel like you have a good one. And palliative care docs, I think this has come to the forefront in the last, I don’t know, five, 10 years, but that palliative care has gotten more of a name, even though it’s always been around. Is it available everywhere? ’cause that’s one of the things I hear is that people say, well, I love it, but I live in a, you know, small town in rural Arizona and we don’t have that.

Dr Matthew Tyler: Yeah. Uh, well this is, uh, good foreshadowing for the other, uh, the other offerings, uh. That I, that I give these days. But no, the honest answer is that, uh, no palliative care is, is not available to everyone everywhere at at least the same high quality palliative care. Uh, what you have access to does largely hinge on where you live, what part of the country, how close you are to an academic medical center, uh, that sort of thing.

And that’s a whole separate conversation that’s related. Um. Certainly where I am starting from with my educating people about palliative care is just to highlight that it does exist. And for most of, most of us, you should have access to some version of palliative care somewhere in the community. Uh, but step one is figuring out do you have it near you and getting you to the point of being able to ask for it, and then a higher level on a systems level.

My secondary goal is to get us all equally demanding palliative care, so it is available everywhere, and that there aren’t disparities in the support that you’ll get when facing cancer or dementia, because that’s, that’s not right. We should all, we all deserve high quality care when faced with these serious things.

Diane Hullet: Yes. Yes. And this, this is a really interesting, I mean, that’s, we’d love to change the system and make the whole thing better. Right. And everybody has to work within the system that. Of the area in which they live for most people, some people travel for certain treatments and so on. But the, but the possibility of there being a doctor and a team that can support you with pain and quality of life seems so critical to me.

Is, is it something that a regular kind of doc can also do, or a, uh, an oncologist should be expected to do? How do they, how do they play together? 

Dr Matthew Tyler: Yeah, so you’re touching on the principle of, of primary palliative care as opposed to specialty palliative care for which, uh, so I, I, I am, my background’s in internal medicine.

I went through a fellowship to specialize in hospice and palliative medicine, where we learn the more complicated facets of, of difficult to control pain. Really high stakes medical decision making conversation skills to get you through the nuances of a complicated medical decision. Um, but. As you’re getting at, yes, every, every doctor should have some level of basic familiarity with, with pain management and talking about your medical choices and talking about your wishes.

Um, there’s always going to be a gap in how things should be versus the way things are. And whatever doctor that you’re working with, you know, there’s gonna be variability in what their individual comfort level is and why it’s so important for me, for you to know your choices when facing. A serious illness, so that way you know what’s normal, what’s not is this, does this doctor have the skills and the training that can kinda meet me where I’m at, so to speak.

Diane Hullet: Right. I, I find that many people are afraid. They’re, they’re deeply afraid of pain at the end of life. And I know Barbara Karin’s, you know, hospice nurse and educator, she says Pain should not be an issue at the end of life in, in our. Uh, you know, current dominant culture, there are good enough pain meds that you should not be in pain, and yet I find it’s still a real fear for people.

Um mm-hmm. Pain and illness or pain at the end of life. Th this is a big fear. And how do you work with families and patients with those kinds of anxieties? 

Dr Matthew Tyler: Yeah, so there’s, there’s a, there’s an education and counseling piece to that, and there’s also, you know, at the end of the day, needing. Basic skills and, and competency and managing pain as a physician.

What I, what I’m frequently reminding folks of is that when it comes to the natural dying process, um, you know, outside of a, a traumatic event like a car accident or something like that, um, death isn’t inherently painful. So if you’ve been living with a chronic progressive illness that by and large hasn’t been causing pain, as you make that transition to the last days of your life.

There’s nothing about that inherently that’s going to cause pain. And I think a lot of folks don’t realize that, and it can be very comforting to know that. Um, but that said, I would agree with, with Barbara Carnes that even, uh, even if you do experience pain end of life, that yes, I mean, we have the tools to manage that.

And by and large, it’s mostly a question of the trade-offs in pain management that you can see at end of life. And, and by trade offs, I mean, that is your body becomes increasingly fragile. If pain is becoming an issue as well. We can typically manage that pain, but it may come with a trade off of being more sleepy, more drowsy as our, our first line intervention for severe pain or, or opioids.

And they, they come with those side effects of drowsiness and sleepiness and I am often having a conversation with my patients and family caregivers about. At their comfort level with that trade off. Are you a person that wants to prioritize being as awake as you possibly can in those last days, even if that means having more pain?

Or are you someone who prioritizes good pain control even if you’re gonna knocked out and sleepy? And I think a, it’s helpful to kinda hear the priorities of the patient as, as their family to make sure that you’re rallying to their wishes. B as the patient, I think it’s incredibly empowering to give a sense of control over what this is gonna look like and as you present options, even options related to your last days, just having some way of kinda shaping that feeling somewhat in control of that can be very therapeutic for folks.

Diane Hullet: Yeah, that makes so much sense that what you just said, that the sense of control or the sense of out of control really matters. And some people wanna hang onto that. And really, for some people being in control might mean not having pain and for other people being in control might be being conscious. So what, what matters to you is so critical.

I really, I think that’s really worth underlining. And how have you communicated that with whoever’s near and dear and around you and helping, whether it’s paid caregivers or most often it’s family caregivers. And are they on the same page? Because I hear people complain, you know, oh, hospice overmedicated, my mother or My mother had this big surgery and now she’s super out of it and this is terrible.

So. Who had the, you know, wheel of the car for that decision making? Who’s driving this and is it what they want? And I think, and I think you think it should be the patient. 

Dr Matthew Tyler: Yeah. No. Yeah. Well, well said. I. 

Diane Hullet: Yeah, well, well said. And easy in theory, but hard to sometimes execute on the ground with actual family members and patients and all of it playing out.

Dr Matthew Tyler: Yeah, I think it’s especially hard if you don’t understand there’s a trade off to be made in the first place. And you know when, when we talk about how palliative care teams help you talk through your options, you gotta know those options to talk through in the first place. And one of the most common things I hear from patients and families when we talk about.

Your wishes related to the end of your life is that they didn’t even know they had a say in it. They just thought this, you just sort of are this passive writer in, in the vehicle towards end of life. And just making it plainly stated that, yeah, you have some options here. And what I try to do is present feasible options.

Right. Um, and a big part of the education is helping people realize that. Part of the natural DI process is that steady loss of consciousness, loss of stamina. And you are naturally going to be sleeping for most of the day either way. Um, and helping, you know, understand, you know, what this is, what this looks like and what’s normal, what’s not normal.

So we can kind of game plan how we’re gonna approach that. And yeah, a lot of folks just don’t have those conversations. And I think you’re kind of getting into. What I’d say, kind of beyond primary palliative care, and we’re having that specialty, palliative care is very important to have someone who is well versed in talking through the natural phases of dying.

As a lot of docs, we don’t necessarily see the natural phases of dying. We see acute illness, uh, we see critical illness, but what the natural progression of dying looks like is often done in a patient’s home. And not a lot of docs actually see that play out in the way that they’re comfortable providing education about it.

Diane Hullet: That makes so much sense. Oh my gosh. My, my head is popping with like three different things to tangents to go off on this one is that, I believe it was JS Park at the end Well conference in November of 2024 that you and I were both at and he talked about how families have to relocate their hope. At some point that, you know, families can hope for a cure and hope for change and hope for the best, and at some point that hope can be relocated to having a quote unquote good death Having a, a.

Pain-free, uh, situation that people are comfortable in their final days. And I, I thought that phrase, relocating hope was really beautiful. So I was thinking of that as you were talking. And then I was thinking when you said that dying is not inherently painful, what is it that does cause pain at the end of life for some people?

Dr Matthew Tyler: Well, that. Has, there’s a lot of facets to that. Uh, pain pain’s a tricky thing to, to talk about at end of life, because I would say for the most part, I don’t get a lot of people telling me that they’re inherently worried about pain or even family caregivers worrying about pain. At least that’s not the word they use.

The, the, the word that I hear people use is suffering, which can be related, but is a very separate entity to pain. Uh, even pain itself, I mean, we, we often kind of jump to the thinking about physical pain, like you hit, you slam your finger in the car or that, that type of pain, the end of life comes a, a lot of other pain.

Uh, the, the existential components of pain, you, of the, the thought of not existing anymore. Um, that’s, that’s a whole mind bender that can cause, uh, all sorts of distress, but it isn’t inherently. Nerve fiber damage that would cause the typical pain that we think about in medicine. Um, there’s the spiritual pain, you know, fear of abandonment from God, or if you’ve done enough to, uh, move on to the next life or whatever you believe there.

Um, maybe you’re having a crisis of what you do believe at, at the end of life. Uh, maybe you have the, the emotional pain of feeling like things were unsaid or undone with the important people in your life. And, and this can all feed into. Restlessness, distress, even feelings of real physical pain that can be hard to untangle.

Um, but certainly if you’re gonna even get close to untangling that not, you have to recognize the different components of, of pain there and how pain differentiates from suffering. And, uh, that can be, that can be a lot. Yeah. 

Diane Hullet: That’s a lot to tease out. It’s a lot to tease out for the dying person and for those who are close to them.

Dr Matthew Tyler: Yeah, absolutely. Um, so it can be hard to make any promises about a lack of whole pain, whole person paying total pain as we’ll, often say in palliative care. Uh, and it’s important to clarify that when we talk about. Dying not being inherently painful. We’re typically talking about physical pain, the nerve, the nerve fiber, damage, pain, what we call that as a nociceptive pain, um, that isn’t inherently painful and we have pretty good medications for the times when there is pain related to that.

You know, certainly if you’ve been living with stage four cancer and you’ve got a lot of bony disease and you’ve had pain related to that, that doesn’t go away at end of life. And I think the, the flip side of the counseling coin is that. As someone loses consciousness or they lose the ability to voice what they’re feeling, we have to be careful to remember that that pain hasn’t gone anywhere, and if they’re looking restless or in distress, uh, the presence of that pain that had been there all along, it’s important not to forget that and, and treat that accordingly.

Diane Hullet: Right. And I know from experience and from people I’ve talked with you, you have to stay on top of pain medication. It isn’t if, if it goes really over the top you, it’s hard to get it back down, right? Mm-hmm. Somebody mm-hmm. I spoke with recently said, pain should really never go over a five on a one to 10 scale.

Uh, you know that if someone’s creeping over five, it’s challenging to get it back down. Is that, is that kind of your experience as well? 

Dr Matthew Tyler: Uh, I, well, I guess I have to disclose here. I don’t love the numbers. Scale now, uh oh. Tell me more. Uh, this, and this may get us on a whole nother tangent. So rain, rain to the end, uh, if you need to.

Uh, I, I think the, the numbers scale of pain is, is tricky as, um, I often don’t know what to do with that, with chronic pain in particular. And what’s, what’s an appropriate number? What’s an acceptable number? And what is a 10? Is, is, is 10, you know, being physically on fire or is a 10 being stung by a thousand bees?

Like what’s a 10? What’s a nine? Uh, uh, is, you know, is a nine a dog bites and, uh, ten’s a shark bites? Uh, what I, what I find a lot more helpful, uh, when talking about pain is more of the. Question of what is this pain keeping you from doing right now? Um, and what would, what would you do with better pain control and, and kind of chase the, kind of the functionality or the functional impairments that pain brings and 

Diane Hullet: right.

’cause that could be as, as complex as pain is stopping me from walking around or moving. Or it could be as complex as, as subtle, I guess I wanna say, as pain is stopping me from resting. 

Dr Matthew Tyler: Yeah, and you know, and there’s, we’re talking about the existential components and the societal components of pain. Pain can, you can sort of get into this performative nature of pain and pain reporting where if someone, maybe someone just lives at a seven all the time and, and, and yet, you know, they need, you know, someone to kind of pay attention to that and, and mind to that.

They may, they may say it’s an eight or a nine just because they know it’s the only way they’re gonna get medications and medications that help them function. Whereas I think it’s just more helpful to say, look like what’s a good day look like for you? Like what’s your, you know, we can sort of start with the numbers and see like, you know, how do we plug this into like a conversation where you can advocate for yourself to other physicians, but you know, maybe an eight outta 10 let’s you, you know, make a sandwich for yourself and nine outta 10 you’re laid up in bed.

Uh, it’s, it’s for me, less about the number and more like, what, okay, well how does this pain interfere with your day to day functioning and. When it’s at its best, what are you able to do? So at least get a sense of what are we, what are we chasing from a person-centered point of view that’s, uh, we can all agree on rather than the number itself.

So, uh, when you, when you plug that back into end, end of life care as well, the number scale gets very, very tricky. ’cause often these folks are not able to talk anymore unresponsive, and they’re not gonna be able to give you a, a five or six or seven necessarily. And you often are looking for other surrogates of pain, like grimacing or moaning or restlessness.

It’s what, what number would you give that necessarily? It’s, it’s kinda hard to tease out and I am often talking to families to help them help me understand what does distress look like to this person? Like what are their tells so that way we can kind of adjust our medications to that rather than a, than a particular number.

Diane Hullet: I love that. Are you sort of an outlier with not loving the pain scale or are other palliative physicians in the same boat that they don’t like it so much? 

Dr Matthew Tyler: I don’t, I don’t think I’m an outlier. I mean, there, there is a, a, a formally, you know, designated functional pain scale that, you know, is part of our education.

And, and I think it’s sort of having those multiple tools in your toolkit for communication and, and complex communication, patient-centered communication is certainly in our wheelhouse. And symptom management’s no different. I think it comes back to, again, less the number, but what, you know, how is this.

Pain or any other symptom interfering with this person’s quality of life and how can we improve it? And uh, just like we all speak different languages, pain’s the same thing. You try to find the right language to connect with patient experiencing the pain and, and go from there. So if a patient speaks them the number scale, I’m not gonna like talk out of it and say that’s, I don’t like the number scale.

Do something like, I won’t do that. But a lot of folks in the struggle to give a number and it’s helpful to have other ways of communicating pain and kind of. When someone struggles with the number, I kind of jump to the functionality and say, you know, what does good pain control look like to you? What’s a good day look like to you?

And let’s talk about how the pain meds fit into helping you achieve those good days and more good days than bad. 

Diane Hullet: I love that. I think that’s so great. I was just glancing down at my phone trying to find, I just in a newsletter this winter, I put up a, an alternative pain scale and it had, I think a six was stung by bees and an eight was attacked by ninjas.

And I forget what a 10 was, but it was like, you know, eaten by a shark or something. And I thought it, it kind of cracked me up seeing this alternative pain scale. So, um, I totally appreciate what you’re saying. And. Yeah, so I go back to what you said. So pain at the end of life there, there can be physical pain, but there often isn’t.

Mm-hmm. And there can be physical pain that comes with a disease process and that’s real and physical. And there can be existential pain, which is a whole different piece. And we have to be aware that. This whole thing of how this is managed depends partly on how cognizant the person is. Can they articulate it?

Can they still speak? Are they not even talking? Are they full? You know, is their mind huddled with dementia and how that plays into you as a doctor, understanding their pain and helping to treat 

Dr Matthew Tyler: Right. Right. Uh, plus a layer in the family components too, when often you’re in those last days and the patient themselves is unconscious and you are looking to the family to help you de, you know, determine is this person in distress.

You can have the families, you know, projecting their own anxieties on, on the patient and perceiving them to be in pain when really that’s, you know, some of their stuff and their anxieties about losing their loved one, or they’re, they’re grieving and that’s manifesting and wanting to, you know, hyper fixate on the, the pain control and.

Maybe the patient looks perfectly comfortable and, and the intervention is less about the medications and more about supporting the family. 

Diane Hullet: Yeah. Was so in, in an if, if you had a patient and family that was sort of like, uh, you know, a model of what you looked at and said, ah, that was, you know, the difficulty of death, but it went as well as it could, what would that family have done ahead of time?

Dr Matthew Tyler: Wow. That’s a great question. Um, so what does a good death look like? Uh, 

Diane Hullet: it’s sort of a model here for what we can, I mean, I think sudden deaths, you know, you either die suddenly or slowly, so a sudden death. There’s no good model for that. Uh, that’s probably not the right thing to say, but. Sudden death, there’s no easy thing to say.

But that’s where there’s time and we know we have some kind of knowing what, what can we do well to be supportive and supported. Yeah. I think 

Dr Matthew Tyler: really ultimately when we think about our, what’s our holy grail of palliative care, you know, for, for a long, long time we have been calling the Holy Grail of palliative medicine, hospice medicine goal, concordant care, uh, which boils down to.

Did the patient with the illness get the care they wanted to, you know, through those last days, weeks, months, years of their life. Um, that is challenging because often our goals can be unrealistic. Uh, our hopes, our hopes can kind of get in the way with what treatment options are feasible. And so if someone’s goal is to achieve cancer remission, and they didn’t achieve that, have we, have, we failed them.

That’s hopefully rhetorical. Uh, I, uh, but you know, for me, what I’m really trying to achieve with all of my patients and, and especially ones with family caregivers, is a sense of we made the right choice every time an option was presented in front of us. And, uh, and especially for families, I try to engender the sense of they did right by their family.

You know, they did right by mom, dad, brother, sister. And that is a very subjective thing, and where the counseling and, uh, presenting of options and the empowerment as they make a choice is, is really where I, I place my focus for patients. It can be tricky because I’m sure, as you know, not, not everyone wants to engage in conversations.

I, I, a, a large chunk of the population of patients I take care of are sort of the person that will say, I will cross that bridge when I come to it. When you try to have a conver like the, the classic like dinner table conversation about your wishes. I mean, as you know, like just some folks aren’t having it.

Like they don’t, it’s not helpful, it’s not therapeutic, it just provokes anxiety. Uh, there, I mean, there’s just folks who have not developed the coping skills to have that conversation advance. And we, and there needs to be a place for those folks to, we can’t, we can’t prescribe advanced care planning or these conversations on everyone as we’re sort of having a reckoning in our field about like lately.

So for patients, it’s really when, when they were presented options, do they feel like they’ve been, you know, presented options? Do they feel like they’re in control of the things that they can control? Uh, do they feel like their medical team is working with them? Um, and for families, I’m really trying to foster a sense of, did, did I do everything I could for my, my loved one and whatever that looks like for them.

Diane Hullet: That’s beautiful. I, I think you’re right that some people don’t wanna go there. And for those who do, I sometimes say like, the first conversation is with yourself. Like being real in your own head with what you’re facing, what will happen and what could possibly happen and, and I think sometimes when people have that conversation in their head, and I always feel like you can’t tell me you’re not having the conversation in your head.

Like everybody’s got a pretty active mind that I know of. So when you have that conversation in your mind with yourself sometimes, then you can have it with the next person out, whether that’s partner, loved one, sweetheart. Grown child, best friend, whatever it is, and then sometimes that can make a difference for how you then interact with your medical team if, if you have the option of having that kind of interaction.

Right. 

Dr Matthew Tyler: Yeah. 

Diane Hullet: So I think that if the possibility is there for some thought ahead of time, it can make things go a little more smoothly. Not always, but sometimes. And I think the, the denial and the, the fear that gets in the way is really something that you and I are both trying to work with the general public on.

Um, but I suspect those people aren’t necessarily listening to the podcast here or checking out your videos on YouTube. Yeah. But I do find it moving that sometimes people stumble on it and they, they kind of have a little light bulb go off like, oh, I didn’t know this was even a possibility. Yeah. And I know I, in my work, and I think you, we look for those little light bulb moments where people are able to make a bit of a shift that makes a bit of an impact on what their experience is at the end of life.

Dr Matthew Tyler: Yeah. I think it really is a, a framework of incremental gains in how you have, you know, having little conversations along the way. Testing your own coping skills and strength along the way, and really having a, a diverse set of things that you draw power and strength from in, in hard times. Uh, and, and I think that’s the, the difficulty is if you have not developed robust coping skills, if you develop serious cancer or, or heart failure.

You, you don’t just suddenly have a bunch of really awesome coping skills. Uh, I mean, those are the folks that really tend to shift towards, uh, denial of refusal to talk about things. And it can get pretty ugly. And it’s just, it’s, it’s hard to see. Um, families are often kind of left flummoxed about how to support this person because they don’t wanna engage.

And even when decisions are in front of them, it can get pretty hard. And, um. This ties back into one of the most common questions that palliative care gets, which is, you know, what are, what are you doing? Like, what are you doing in palliative medicine and what, what, when we talk about folks who get early palliative care and how they have better quality of life, and in some cases even better survival, the question’s always well, but what did you do palliative team?

Like, what did you do? Um, and we’re getting a better appreciation on a large part of what we do is help develop coping skills. Um. But you can’t do that in one visit, uh, or one day, um, e even a week. Those are, you know, skills that you build, you know, bit by bit over a long relationship. And, um, and certainly, uh, the, the big question of how do we, how do we get people engaged in that?

How do we get people to begin to cope? Um, you know, that I don’t, I don’t have the answer to it, but I know it’s gotta, it’s gotta start early. And maybe having that conversation once or twice or three times might help kind of push, push things along. 

Diane Hullet: That’s really beautiful that it’s coping skills and, and it’s coping skills of the one person, but it’s really coping skills of the family system.

And I keep saying family, but I, I mean that really loosely. ’cause I think there’s birth families and chosen families and all, everything in between, but I. Whoever your people are, and some people have no people, so that’s a whole other difficult thing. But these coping skills so that you’re having conversations and beginning to row in the same direction.

You know, I always picture a family of as being on one of those like tightly balanced skulls, you know, that fit a bunch of people on ’em, and if one person is rowing backwards, it messes up the whole, the whole system is outta whack. So how do you kind of get to where you’re pulling in the same direction ideally.

With the direction having been laid out by the person who is at the center of the health situation. Yeah. Well, I really always love talking to you, Dr. Matthew Tyler, and, uh, we’re gonna chat again next week, but for now, tell folks how they can find out about you and tell them about the consulting work that you do as well.

Oh yeah. 

Dr Matthew Tyler: Thank you. Uh, so if you want a central hub of where to find me and see what I’m doing, I just head over to How to Train Your doctor.com. That’s got links to all my socials. Um, the social that I’m most active on is, is on Instagram, although I have a presence on Instagram, TikTok, YouTube, all under the same handle.

How to Train Your Doctor. And, you know, my, my goal, the, the videos that I’m making on social media is to provide you as much education as possible to be a savvy patient, a savvy caregiver. Who can understand that you have choices and can use your voice, uh, and use language that your medical team will understand, so they can get behind your wishes too.

Uh, but going back to our early point about if, if I’ve already convinced you that palliative care is awesome and you want it, you know, what do you do if you don’t have access to it? Or, or you’ve worked with the palliative care team in your area and maybe you’re not clicking. This year I have rolled out what I call caregiver coaching services, where we can meet one-on-one, uh, over, over teleconference and we can just kind of talk through some things that you’re thinking about, some problems that you’re wrestling with, and I can help function as a sounding board, uh, bring in the insight that I have as a palliative doc to the conversation to kinda help you, help you get on the right track with what to do next.

Diane Hullet: Super. I think that’s a tremendous asset to offer the community that, you know, you’re based in Chicago, but you don’t have to be in Chicago to tap into your excellence and your education and your understanding of how palliative care can make a situation. Better, which I think is the goal. Well, thanks for joining me today, um, Dr.

Matthew Tyler, and you can always find out more about the work I do at Best Life. Best death.com. Thanks so much for listening, and tune in next week for another round with Dr. Tyler.