Maggie Maher, a health blogger we read regularly, has a poignant post today about untreated pain, inappropriately aggressive high-tech care, and the lessons that young medical students (not to mention some older doctors) still must learn about why "good care" and "cure" are not synonymous.

Maher spent some time with Dr. Diane Meier, a geriatrician and national leader in palliative medicine at Mt. Sinai Hospital in New York, and she watched Meier share with medical students some of what she has learned about how to help seriously ill or dying patients. I learned a lot from Meier and her colleagues at the Center to Advance Palliative Care last year when I was doing an extensive reporting project on palliative care and hospice. (Click here, here, and here).

Palliative care (which unlike hospice does not preclude curative treatment and which is not only for people expected to die within a few months), is better understood and more widely available than just few years ago. But the health care system, with its emphasis on a high number of elaborate procedures, still undervalues it—even though palliative care's emphasis on getting patients the most appropriate care can often save money. As Maher writes:

Clearly, we need more palliative care specialists like Meier. But this is another case where we don’t pay enough for “thinking medicine"—which involves talking to and listening to the patient—rather than cutting him or radiating him.

“When a three-person palliative care team made up of a doctor, a nurse, and a psychologist spends 90 minutes in a meeting with a family, Medicare would probably pay $130 to $140—for all three people,” Meier told me. “And Medicare is one of the better payers.” This explains why Meier earns $100 for every several thousand dollars that her husband, an invasive cardiologist, takes home. “Though,” Meier said mildly, “it would be hard to say that one of us is practicing more sophisticated medicine."

BMJ, the medical publishing conglomerate, recently got 4,000 responses to an online poll asking people to rank six areas where doctors could make the greatest difference to patients. Number one: more palliative care.