Ariadne Labs recently welcomed Dr. Erik Fromme as the director of the Serious Illness Care Program. Fromme received his BA in psychology from the University of Virginia and MD from the University of Oklahoma. He completed his residency in Internal Medicine at Oregon Health & Science University (OHSU), as well as a master’s in Clinical Research and the Interprofessional Fellowship in Ethics. He completed fellowships in General Internal Medicine at Johns Hopkins Hospital and Palliative Care at Massachusetts General Hospital, where he was also a Schwartz Fellow in Pastoral Care.
Fromme comes to Ariadne from OHSU, where he was the section chief and medical director for Palliative Care and founder of their outpatient palliative care program. He developed a research program in patient-reported outcomes, hospice and palliative care health service, as well as the Physician Orders for Life Sustaining Treatment (POLST). He assumes the role held by Dr. Susan Block, who founded the Serious Illness Care Program at Ariadne Labs and is now serving as a senior faculty member to the program.
In addition to his duties at Ariadne Labs, Erik is a member of the Department of Psychosocial Oncology and Palliative Care at the Dana-Farber Cancer Institute and the Division of Adult Palliative Care at Brigham and Women’s Hospital. Fromme recently spoke with Margaret Ben-Or from the Ariadne Labs Communications team about how he found his way to serious illness care and the future of the work.
Erik, welcome! How have you been settling in?
Thank you! It’s been busy but great. It’s exciting to dive into everything that is happening. The program has a lot of moving parts. It sometimes feels like I have a big funnel over my head, and information is just pouring into it.
I bet! What are your initial takeaways from these first few weeks?
Two things. I’m so pleased to see the demand for the program, though I’m not surprised. I’ve been in the position before where I wanted to improve how we were caring for seriously ill patients at a system level and needed a lot of help and guidance to figure out how to do that. It’s not surprising to me that other people are at the same place, whether it be an individual practitioner, a health system, or even an entire state trying to take this on. The second thing: I really like my team here. They are just great, and I’m really excited to work with them.
Did you always know that you wanted to work in palliative medicine and serious illness care?
When I was applying to med school and residency, I thought I would do primary care. I’m from Stillwater, Oklahoma, and I always thought I’d go on to practice in a rural setting. But I was wrong!
What brought you to this field then?
I think that’s a two-part answer. I really love to teach. I approach everything as a teacher, even being a doctor. While practicing primary care in Portland, Oregon, I decided to apply for a medical education fellowship at Johns Hopkins. My wife and I moved to Baltimore. Once I was there, everything I did overlapped with serious illness care. I did a qualitative study on how the experience of being a cancer patient changed how physicians approached their own practice. That led to developing a palliative care curriculum for Johns Hopkins and Bayview Medical Center. And then I met Andy Billings, a pioneer in palliative care, who became my mentor and encouraged me to do palliative care fellowship training.
The second part of the answer took me several years to recognize. After my fellowships, we moved back to Portland, and I practiced palliative medicine. I attended a training about recapturing the heart of medicine with Dr. Rachel Naomi Remen, a wonderful physician and teacher based out of the San Francisco Bay area. Before the training, she asked participants to bring an object that represents our approach to medicine to share during a small group activity. She said “if you don’t know what to bring, don’t think too hard about it,” so I grabbed the first thing I saw on my desk. When it was my turn to speak during the activity, I was totally dumbstruck. I really wanted to speak, but I just couldn’t. It lasted a long time, but my small group waited very generously until I was able to speak. My object was a statue of Jizo, the Buddhist protector of lost children. It had been given to me and my wife after the first of many miscarriages, which happened right around the time we moved to Baltimore four or five years earlier. In that moment, holding the statue in my hands, I understood that for me, the energy to do this work comes from the same place as a parent’s love for their child.
That is a beautiful way to describe what it’s like to care for patients. Do you think that same energy comes into play in your role as the program director?
Absolutely. I felt the same energy calling me when I considered accepting this position. I see myself as a servant, and that’s what service is – when you are called, you go. When you see patients, it is more obvious who you are serving. They are literally right in front of me. I’ll still get to see patients, but as director of the Serious Illness Care Program, it puts a lot more people in front of me by extension.
The program certainly has the potential to reach patients on a massive scale. What would that look like?
If we’re really successful, serious illness conversations won’t require a whole huge implementation plan, it will just be routine. I think of it like informed consent–the conversation a surgeon has with a patient before an operation. No doctor today would say “I’m too busy to do informed consent.” With time, practitioners will just think “I need to have a serious illness conversation with this patient.” It will feel like it’s just something they expect themselves to do and feel well prepared to do.
How do we get to that point?
I don’t think it will take a lot to convince doctors and other clinicians of the value of serious illness conversations. These conversations remind doctors of the roots of why they went into medicine. Most would agree this is an important thing to do, so then the challenges are time and fears. The pace at which we practice medicine makes it hard. The average serious illness conversation is 18 minutes; the average primary care appointment is 15 minutes. That’s a challenge, but the conversation isn’t about the doctor and patient alone. It’s about the family and the other health professionals who are there too. Doctors may have a point when they say they don’t have a lot of time, but where they are wrong is that doctors often think they have to do it all by themselves. Our study with the Integrated Care Management Program is an example of how these conversations can be successfully managed by a clinical team together.
Atul likes to say that our goal in serious illness care is not about a good death, but rather living well to the end. Do you agree?
I do, and I think an important first step to getting there is making it ok to talk about death. It doesn’t serve us well to be wrapped up in the idea of death, but it can be a reminder to keep pursuing a life well lived. Mr. Rogers said, “Anything that’s human is mentionable, and anything that is mentionable can be more manageable.” Making the idea of death ok to talk about allows us to get it out there so that we can get past it and talk about living the life we have right now in this moment.