Dr. Alisha Benner shares the impact and importance of palliative care as a palliative medicine physician with Duke University Health System. She’s also an assistant professor at the Duke University School of Medicine and the program director of the Duke Hospice and Palliative Medicine Fellowship.
“It’s important to find good mentors – female mentors – and then become a good mentor,” she says. “Pay it forward.”
By Amanda MacLaren | Photography by John Michael Simpson
Amid the bustling corridors and near-constant hum of activity at the Duke Cancer Center, Dr. Alisha Benner knows the value of two important tenets of palliative treatment that can be rare to find in modern medicine today: silence and time.
“You should never speak more than 50% of the time in any patient interaction,” Alisha says of providers of palliative care, a relatively new medical specialty with expertise in treating both physical and emotional symptoms for those with serious illnesses. Palliative medicine clinicians work intimately with patients and the rest of their medical team to help them navigate their health care in all its stages and understand treatment options with the goal of providing expert symptom management and emotional support for them and their loved ones along their medical journey. “Silence is actually one of our most important tools; it’s in that quiet space that we can learn a lot from our patients – how they’re feeling, their insights into their health status, what they are worried about, the important, hard questions they have, and really allow them to consider their options.”
The focus on time with patients is what initially drew Alisha to the field of palliative treatment, which was still in its early stages as a speciality when she went back for a fellowship in palliative medicine training at UNC after working as an internal medicine hospitalist at WakeMed in Raleigh for 10 years. “The thing I really enjoy about the hospital setting is I can spend as much time with patients and families as I need,” she says. “There’s nobody saying, ‘Your 15 minutes is up, you have to move on;’ it lets me have time with patients and build those relationships, and I really value that. At the end of the day, these are people, and the more you get to know them, the better we’re able to take care of them.”
Palliative Medicine vs. Hospice
The main difference between palliative care and hospice is that palliative care is a subspecialty of medicine, similar to seeing a cardiologist or oncologist, and can start at the time of diagnosis for advanced illness whereas hospice is an insurance benefit only for those diagnosed with a terminal illness and are predicted to have fewer than six months to live and who wish to focus on comfort at home.
She’ll spend a half-hour with a follow-up patient, and an hour with new patients, learning about their needs – emotional and physical – and what is most important to them while “taking the temperature of the room to mold our discussion in a way that feels right for how they are feeling that day,” Alisha says. She helps them and their loved ones – “Disease is not an individual patient experience,” Alisha emphasizes. “It’s a family experience, whether biologic or the family you create.” – understand what the trajectory of their diagnosis is likely to look like so that they can make decisions on how to spend their time.
“I’ll say to patients, ‘Sometimes people just get really sick and tired of being sick and tired,’” Alisha says, “‘and they nod, and say, ‘Yeah,’ and they need to hear that it’s OK to feel that way, right? There are often times that patients feel they just have to be fighters – their family wants them to be fighters, society wants them to be fighters. But I think that’s a very tough burden to place on a patient, because with disease, particularly for cancer, improvement or decline is made at a molecular level. It’s not based on the will of the fighter.”
As a palliative treatment professional, Alisha frequently reminds her patients that the goal of their meetings is to ensure that they have as many good days – whatever that looks like for them – as possible, and it’s her job to help them have that kind of day.
“The rewards are frequent in the work that I do,” Alisha says. “A lot of people say, ‘I don’t know how you do what you do; I could never do that,’ and I would share that, the reality is that nobody lives forever. And so if we can help people have a good journey and a soft landing, that’s a big deal.”
“‘Don’t kick the joy can down the road’ – nobody knows how they’re going to feel later, so I encourage my patients to do the things that are important now. I always want people to say, ‘I’m glad I did,’ not, ‘I wish I had.’”
Dr. Alisha Benner
House Calls
Alisha practices what she preaches to her patients, taking time to find joy in the “good days.” She seeks solace in nature – “I’m very much into being outside; exercise gives me a lot of relief, it fills my bucket” – and advocacy work like registering people to vote and encouraging voter turnout, underscoring her commitment to social responsibility beyond the realms of palliative treatment. “I’ll go wherever the need is,” she says of her volunteerism with organizations like the Durham County Democratic Party and Orange County Democratic Party. “I’ve written postcards. I’ve done phone banking. I’ve done canvassing. I’ve done it all. I find helping people get to the polls to be the most rewarding.”
She and her husband, Dr. Eric Benner, a neonatologist at Duke, have three sons – Jack Benner, 14, who attends Duke School, and twins Ethan Benner, a first-year student at UNC, and Gavin Benner, 19.
“My twins were born three months premature, which is how Eric actually got into neonatology,” Alisha says. Ethan, a chemistry major, is taking a bioethics class, and recently asked his mom for a bit of advice. “They were doing a unit on patient-doctor communication, and he messaged me saying, ‘I really want to get your input as a palliative medicine physician,’” she says. “My heart swelled 10 sizes. I was like, ‘Nothing would give me more joy.’”
Gavin has what is commonly titled “typical autism,” Alisha says, and is minimally verbal, requiring 24-hour supervision. She notes the issues related to the under-recognition of the needs of intellectually disabled (IDD) adults, especially in supported employment (aides hired to provide 1:1 supervision at the job site) opportunities and safe, quality residential options. Around 0.5% of the US population, roughly 1.7 million people, have severe IDD, Alisha says, adding that she believes concepts such as tax benefits for businesses offering supported employment; government grants to encourage innovative residential options; and low-cost or free housing for students interested in health professions to live with IDD adults, providing companionship and gaining valuable experience while reducing their financial burdens, would greatly alleviate some of these challenges.
