Q&A with Mihir Kamdar, MD
August 14th, 2020
Mihir Kamdar, MD is Section Head of Palliative Care at Massachusetts General Hospital and Director of the Mass General Cancer Pain Clinic. He is also an Instructor in Medicine at Harvard Medical School and serves as Course Faculty for Palliative Care Education and Practice.
Why did you decide to work in palliative care?
Palliative care wasn't on my radar at all when I was first thinking about career choices in college and, in fact, I wasn't even thinking about going into medicine. During my freshman year, my grandmother, who was from India and who I grew up with in our home, was diagnosed with metastatic colon cancer. I remember being in the hospital and seeing the way that her doctors and nurses were able to convey a sense of empathy and caring - despite the differences in language and background – and that felt so powerful to me. This real, human connection gave me a lot of comfort amidst a really challenging time. That got me thinking a lot about what I wanted to do with my career and I decided to shift to pre-med.
After medical school, I came to Boston for residency. This was around 2005, when palliative care still wasn't in most places. I was first exposed to palliative care during my first month of internship while on an oncology rotation. When you're an intern, you're getting paged for things like pain, nausea or because someone is rapidly becoming critically ill at 3 am and we needed to have an urgent goals of care conversation. To me, helping these patients and families through these moments was the essence of what it means to be a clinician. I found that there was a lot of importance and reward in trying to help patients feel better. It was powerful to see the joy that it brought patients to even just be able to eat a sandwich after being nauseated for weeks or the relief in the face when their pain was relieved. I also enjoyed being able to help patients and families navigate the hard decisions that they were facing and make sure that their medical care was tailored to what mattered to them. That was my “a-ha” palliative care moment when I realized this is what I wanted to do with my life.
I also knew I really liked using my hands and, in palliative care, we see a lot of challenging pain syndromes. Because of that, I wanted to be able to offer minimally invasive procedures like nerve blocks or pain devices to patients with challenging or hard to manage pain when nothing else is working. I completed both a palliative care and anesthesia/pain fellowship and combined those two in my palliative care practice with a particular focus on cancer pain.
Tell us about your research / area of expertise.
With my background in both palliative care and interventional pain, much of my research and clinical work centers on the management of refractory pain syndromes. However, because palliative care is still a relatively young field, another area of interest for me is designing optimal care delivery models for palliative care in general as a field. I’ve been able to work with some pioneers in the field, such as Drs. Jennifer Temel and Vicki Jackson, and I’m currently a co-investigator on one of Dr. Temel’s multi-center clinical trials looking at the use of telemedicine in early palliative care.
I’m also very interested in the use and innovation of digital health in the care of patients with serious illness. Several years ago, we created a digital therapeutic smartphone application called ePAL that was designed to help patients with hard to control cancer pain, which effects 70-90% of patients. Cancer pain obviously impacts the quality of life of patients and families, but it also drives a lot of healthcare utilization in oncology and is a leading factor for patients getting admitted to the hospital. We studied ePAL in a randomized control trial and saw that patients had significant improvements in pain, significant improvements in indices of feeling empowered to manage their pain, and also an almost 70% reduction in the likelihood of being admitted to the hospital due to a pain-related issues. This was one of the first studies that showed that we can use innovation and digital health technology to help patients with serious illness, and I think that's an area of growth and opportunity for the field moving forward.
When thinking about the future of palliative care, what excites you the most? What do see as the biggest challenges?
One of the most exciting things about palliative care is how fast the field has grown over the last decade, which I think is a sign of the value that palliative care brings to patients, their families and to the healthcare system. The dilemma is that we don't have enough palliative care clinicians presently and, with the aging of our baby boomer population, the estimated palliative care needs in the US will likely double over the next 25 years.
Hence, the biggest challenge facing the field is how we rise to meet these burgeoning needs in a way that doesn't burn out our limited resource of palliative care clinicians. I think there's a real opportunity to think about telemedicine, digital health, and artificial intelligence as a way to address this issue. If we can expand innovative models of care like ePal, telemedicine, and video visits, it allows us to extend palliative care into the home and keep people out of the hospital. If we can do that, that not only helps patients, but it also allows palliative care clinicians to reach more patients and spread the touch of palliative care into areas of the US, both rural and urban, where there isn't good access to palliative care. It's an interesting paradox because sometimes we think of technology as separating people, but if we use well designed interventions, we actually could use and harness technology to bring our patients closer to us. I'm excited about that possibility.
What’s your favorite part of your job?
Patients let us into their lives in these very vulnerable moments and that's a privilege that you never take for granted. For me, the ability to get to know my patients and their families on a human level and help them navigate the challenges that they face is incredibly rewarding. I'm often inspired by the grace and courage with which they face their illnesses. It gives me a different perspective with which I view my own life and whatever challenges I may be facing, and it’s often a reminder to always be grateful.
My other favorite part of my job is working with our wonderful team of nurses, social workers, chaplains and physicians at Mass General. And I continuously find myself grateful for their kindness, camaraderie, sense of humor and for their high level of skill and compassion that they bring to our patients every day.
In your spare time, what do you do for fun?
I'm lucky to have a beautiful wife who works in the arts and, when we're not in the middle of a pandemic, I love to go to museums with her. She teaches me about all these different artists and the context of why their art is significant. It triggers a very different creative and experiential side of the brain than day to day medicine, which is wonderful. We also have a seven and a half month old named Gia and she's just a bundle of joy. Being able to spend time with her and seeing her grow, it's just hard to describe how special that is. I’m also a big NFL fan and have the curse of being a Minnesota Vikings fan, which is an emotional roller coaster every fall, but I ride with them no matter what!