Inside Track: A palliative pioneer
Dr. John Mulder’s work integral in establishing and expanding care for patients with life-altering diseases.
When Dr. John Mulder began his career more than 30 years ago, the field of palliative care did not exist.
It has been his work, along with others’, that has established and expanded the advancing form of care, which uses the values formed in hospice to improve quality of life for patients with life-altering diseases.
Hospice is more than just a last resort for dying patients, as some think, Mulder said. It’s meant to improve quality of life and honor patient preferences, walking terminally ill patients through the end of their lives.
“We're not there to help people die. We're there to help people live, and to live well, to live abundantly,” he said.
An oncologist, for example, is trained to treat cancer, not necessarily addressing anything that goes along with it, while the goal of palliative care is to manage a disease’s complex symptoms while helping patients understand the nature of the disease, creating treatments that align with patients’ individual goals.
Mulder is medical director of Holland Home’s Trillium Institute, which was launched as a trial six years ago to help to increase the awareness and availability of palliative resources in the community.
“We were hoping that we would see the kinds of results that we're seeing,” he said.
When he first started this work in West Michigan, there were only a few palliative care doctors scattered throughout the area. Now, there are more than 50, many of whom he has trained, he said.
A 2018 study by the Coalition to Transform Advanced Care ranked Grand Rapids as the “best place to die” among nearly 300 regions in the U.S., and Mulder said he believes that can be attributed in part to the palliative care in the region.
Too much of what happens in medicine, Mulder said, is doctors are focused solely on treating diseases, completely ignoring what patients think. Sometimes, extending life by a short time isn’t worth the hassle to patients if it means their final days are unenjoyable.
One of Mulder’s cancer patients, for example, was told he had a year to live without treatment, maybe two years with treatment. But what the patient wanted to know was: “How many days am I going to feel good enough to go fishing?”
“My job is to make sure that he's out fishing as much as he can,” Mulder said.
Another patient’s goal was to walk his daughter down the aisle on her wedding day. With that in mind, Mulder recommended the patient wait for treatment, which could have kept him away from the wedding completely, rather than putting him on performance-enhancing drugs.
“He put his walker aside, walked her down the aisle and danced with her at the reception,” he said.
Mulder said he didn’t have a lifelong dream of being a doctor.
After high school, he attended Western Michigan University, mostly to have fun with his friends, he said. Though he always was interested in the sciences, he said he had no real direction.
Mulder said he was impressed with a biology professor during his junior year and voiced the desire to follow in his footsteps. But the professor said no, that Mulder should become a doctor.
“Even though my grades didn't reflect it, he saw something that I don't think I saw myself,” Mulder said.
With “mediocre” grades, same with the MCAT score, he was denied admission into medical school. He went to graduate school instead and started teaching at Wayne State University School of Medicine.
He applied for medical school again and was denied. Ready to give up, his undergrad biology professor convinced him to try one more time.
He retook the MCAT and applied for the third time. This time, he was accepted to Wayne State.
Midway through medical school, he decided to become a family doctor. He moved to Grand Rapids to complete a residency after graduating in 1980, and he then began practicing in Muskegon.
It was perhaps the experience of watching his father’s end-of-life care that influenced him to later pursue his specialty, he said. Mulder’s father was diagnosed with stomach cancer on Memorial Day 1979 and died the same day one year later, days before Mulder began his residency.
“There was virtually no such thing as hospice,” Mulder said. “I don't think ‘palliative care’ had been invented yet. So, there really was no coordinated approach to end-of-life care.”
He said his father suffered a lot of symptoms during his last six months.
“We as a family suffered not only because he was suffering, but because of a lack of information, lack of knowledge, lack of planning,” Mulder said.
He died in the hospital, but the family didn’t know that was going to happen, and Mulder said he hadn’t been taught how to recognize the signs of dying.
In 1984, Mulder was invited to serve on the board of Hospice of Muskegon and Oceana County, now called Harbor Hospice. Hospice was added as a Medicare benefit only a year before that.
“I had no idea what that was, but I was a new doc in town, had some bandwidth, so I said I would,” he said.
Mulder learned more about the program and realized how valuable it could have been when his father was sick. He later became the organization’s medical director.
In 1997, he and other doctors involved with hospice formed the American Board of Hospice and Palliative Medicine, which, since 2006, is the official certification body for doctors in that field.
A couple of years later, he decided to really put his knowledge and experience to use. Mulder did a lot of international travel as board chair of medical relief organization International Aid. During a layover in Bangkok, he became seriously ill, unsure if he would survive.
“In the process of that, it was a really interesting opportunity for a reevaluation,” he said. “I realized I was probably pretty comfortable in life, and perhaps, I needed to look at challenges that could really expand my capabilities while helping the community.”
On the heels of that experience, he took a job as chief medical officer of a hospice organization in Nashville and began teaching end-of-life care and palliative medicine at Vanderbilt University School of Medicine. During that time, he launched palliative programs at three hospital systems, a children’s hospital and began working at an embedded palliative clinic.
“My time there in Tennessee really helped solidify not only a continuing interest but capacity in working in this field and helping to forge new programs,” Mulder said.
He moved back to West Michigan in 2006 to lead the development of Holland Home’s hospice program. He later started the programs at Metro Health – University of Michigan Health, including at its cancer center, and at Spectrum Health.
He’s also an assistant professor at the Michigan State University College of Human Medicine and director of the Mercy Health Grand Rapids Hospice and Palliative Medicine Fellowship Program.
Earlier this year, Mulder won the 2019 Project on Death In America Palliative Medicine Community Leadership Award from the American Academy of Hospice and Palliative Medicine for his work in the field and his role as a mentor for medical students.
Mulder said his hope is that the practice of palliative care increases to the point that spreading awareness is no longer needed.
“I think that in a perfect world, we don't have independent hospice organizations,” he said. “We've taken the expertise that hospice has helped to develop, and we've integrated that into all layers of our traditional health care system.”