Directing the future, with care

Dr. Glen Komatsu

Interview by Stephanie McPherson  /  Photographed by Taso Papadakis

Glen Komatsu, MD, is trying to bring the “care” back into health care. For years he struggled with a one-size-fits-all approach to medicine, and as a neonatologist he saw families’ desires pushed into the background, as doctors battled to save every life without regard for the quality of that life. 

His perspective shifted during a year-long Harvard Medical School fellowship in palliative medicine, a specialty focused on alleviating the symptoms and stress of serious illnesses. Offered at any stage of disease—and often in conjunction with curative treatments—palliative medicine emphasizes the patient’s desires for his or her care, balanced with the reality of their medical condition.

Dr. Komatsu is now the Regional Chief Medical Officer of Hospice & Palliative Care for Providence St. Joseph Health, Southern California. As part of his work, he spends time at Providence Little Company of Mary Medical Center Torrance and San Pedro, where he hopes to bring some of the ethos of the specialty to health care in general. 

How do you think medicine can generally benefit from the methods and philosophies of palliative care?

We have lost sight of the human qualities of caring. We’re focused on the prevention, diagnosis and treatment of diseases, and we’ve lost sight of the individual human experience of illness. The example I give many times in my talks is: If you have 50 women with the same stage, same cell type, same markers of breast cancer, they all are treated the same, because we know from the medicine and the science that this particular cancer responds to this particular treatment and has the highest chances of good outcome.

But what we don’t take into account in modern health care is the individual experience of each of those 50 women. Each of them will go through this journey in a very different manner and will need specific kinds of support, encouragement and treatment to help them get through the experience. 

How can these methods be incorporated into modern care? 

We just need to listen to patients and families. We need to focus on patients’ comfort and quality of life. We need to ask them what’s important to them on a regular basis, to make sure that our treatment is aligned with their goals and that we’re doing things that are helping them—not causing “dis-ease,” more pain and more suffering. We have to keep listening and asking in a way that allows people to answer and think about what’s important to them. 

In the vein of understanding a patient’s wishes, why should someone arrange to have advanced directives in place?

Advanced directives are documents that can express what your wishes are and what’s important to you. If you can’t speak for yourself, they can also designate a person to speak for you. 

But it’s not the document itself that’s so critical, it’s the conversation around the document. For instance, “I don’t want to be kept alive on machines. I don’t want dialysis if my kidneys fail.” You can always change your mind, but having the conversation helps both sides. Both the person and the family better understand each other through this conversation.

Is it important for people to have these in place even before they get sick? 

Absolutely. In fact it should be done when you’re not sick. Anybody who is over 18 should have the conversation. People make different decisions when they’re sick versus when they’re healthy. Sometimes it’s easy to say when you’re healthy that you wouldn’t want to be dependent on machines, and then when you’re faced with the prospect of being on dialysis or dying, some people change their minds and say, “Oh I guess maybe I will try dialysis for a while.”

You are also the chief medical officer for TrinityCare Hospice—which includes TrinityKids for terminally ill children. How does palliative care factor into this work? 

While a cure is always the first goal of medicine, it may not always be possible, and we have to be able to focus on healing as opposed to curing. Healing is where a person—the child, the family—becomes transformed by the illness experience and actually leans into the pain and suffering, understands that it’s part of living, comes to terms with that, and is able to find the gratitude, love and compassion in life.

The work is very hard, and the parents are in agony. It’s not that we can fix that—we can’t take away their pain, we can’t ease their pain. But what we can do is keep showing up. We can show them that we’re going to walk alongside them, no matter how bad things get, so they don’t feel like they have to go through this alone. Our presence alone is comforting and therapeutic.

That’s what human beings do for each other, and I think we need to get back to that in medicine. Understand that we can’t fix everything, but we can be present with our patients and treat them as fellow human beings as opposed to “us” being the well and “them” being the sick.

How is the Palliative Care Service at Providence Little Company of Mary Torrance unique? 

I want people on my palliative care team to be leaders—not only great practitioners clinically, but leaders in the field who can help change the culture of this institution and the culture of health care at large.

The vast majority of hospitals have palliative care now, but their focus is on seeing the patients that need help, which is of course the primary function. But our vision goes way beyond that in terms of helping bring more humanity into health care. 

Creating an advanced directive

Completing an advance directive can be accomplished in five easy steps.

STEP 1: Choose your health care representative.

STEP 2: Make your health care choices.

STEP 3: Outline your health care representative’s authority.

STEP 4: Sign the form.

STEP 5: Submit a copy of your completed advance directive.

If you have any questions as you complete the form, please talk with your doctor. He or she can explain what the options may mean for you and your family.

You’ll find more useful information here: https://www.providence.org/institute-for-human-caring and downloadable/fillable PDF forms here: Provhealth.org/AD.