Thursday, March 25, 2010

Palliative care---here we go again

Last week the Dinosaur wrote an insightful post of particular interest to me: Palliative Care: An Unnecessary Specialty. In reply Bob Centor at Medical Rants defended palliative care, but as a level of organization, not as a specialty.

Dinosaur's post reflected a lot of my concerns. I would be open to the notion of palliative care as a unique specialty if someone would tell me what it is, exactly. The trouble is, no one seems able to do that. Many folks talk around the issue. Some talk about palliative care as an end of life care modality. Others say just the opposite, that palliative care does not depend on prognosis and may be given right along with curative, life prolonging care. Most apologists for palliative care have at least this idea in common: that palliative care provides excellence in symptom relief, communication with patients and families, and coordination of care. But those are just basic tenets for all care, at the bottom of the pyramid of principles of good old fashioned doctoring! So why a specialty?

One of Dinosaur's commenters was R. Sean Morrison, MD, president of the American Academy of Hospice and Palliative Medicine. Even he couldn't seem to nail down a definition, merely characterizing palliative care as excellence in the care of very ill and complex patients.

Another commenter, Christian Sinclair, MD, author of the Pallimed blog, didn't define the specialty but gave an honest appraisal of why we need palliative care teams: severely ill and complex patients and their families need time and attention to detail. Economic and administrative barriers do not allow this to happen in ordinary primary and hospital care. Somebody has to be there to do it.

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