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I did not receive teaching or training in palliative care. Having recently experienced poor end-of-life care for my mother, I applaud the CPSO initiative to educate everyone about this. Without a doubt, there should be mandatory palliative medicine rotations in all post-graduate training programs, including surgical specialties.
First, though, we must adopt a more mature attitude and accept death and random events as part of life. Stop using military analogies when speaking of diseases – fighting, winning battles – so that patients do not feel like failures at the end of their lives. Dispel the myth that if we did all the right things (diet, exercise) we would always be healthy.
Educating the public is as important as teaching health practitioners. Part of my mother’s end-of-life suffering was due to her refusing hospice care because, in her mind, it meant that she was weak, that she was giving up her “fight against cancer”.
I am personally going though this myself. My father has lung cancer of the one lung he has left. Our family doctor was very thorough with him 20 some years ago. I’m not sure if it was in his nature or due to him recently graduation University. I am thankful either way. I still find that our doctor is very compassionate after 20 yrs he still asks how my family is doing and making sure I understand how fortunate I am to still have my father with us due to the type of cancer. Back to the subject at hand, I think it’s a great idea to incorporate a rotation that involves working at a hospice or end of life treatment hospital. It wouldn’t hurt to have and understand compassion. Facing death is not easy, no matter who we are. We just have to be tactful and have “bedside manners”, ethics/morals, and be understanding toward families etc.
Even as an Oncologist (& former palliative care practitioner) I was unable to secure an ambulatory palliative care appointment for my father, who had symptoms from head and neck cancer. Most resources (locally) are focused on end-of-life care at the bedside. It is ironic since the majority of data availalble now suggest early palliative care intervention improves quality of life, reduces hospital admissions and complicated problems. Even prolonged median survival was noted in a randomized study of lung cancer patients. Cancer Care Ontario could put more resources into mandating ambulatory care, in my opinion. Interestingly, as a medical educator I have noted resistance (from medical colleagues) to introducing palliative care curriculum early in medical school. The sentiment often expressed is the material is “too intense” or “upsetting” for the students. (Interestingly, the students recognize the importance and in time, minimize the anguish experienced). .However, I believe it is our responsiblity to aclimate and support students as they learn palliative and EOL care. Much of medicine is focused on care for those with advanced disease. Symptom management and EOL care must be viewed as a fundamental competency. To this end the CPSO must be commended for this initiative.
I have to agree. We do need to teach our new doctors about End-Of-Life care as part of their curriculum as it’s not a very easy process or topic to deal or cope with. We all go through this, and whether we are students of medicine or a family member, we need compassion. As it mentions in “Beginning a dialogue on the end of life care”, the number of elderly individuals will increase in number, and actually double by the year 2036. Therefore, we should educate our new doctors on how to approach, teach and educate the pt’s, families and the public about proper end of life care (pain management and quality of life) and what options are available to them.
I believe that basic training in palliative care principles should be part of every physician’s training. Clearly, a physician who intends to specialize in pathology or radiology will need less than those interested in providing, for instance, comprehensive care, but some time spent exposing medical students to this area will never be wasted.
All physicians should have some training in end of life care. Providing end of life care in the home should not be obligatory for any physician , only those that are willing.
I think we have to respect that each of us have different situations that may or may not allow us to do palliative care in the home. Our duties and workload are already heavy, to add further to this with obligatory palliative services is not fair, and not manageable for some our homelife situations.
Palliative care could be a discipline, speciality on its own.
I work on palliative program for many years. I think patients lost control over their body at the moment they heard from the doctor they trusted, the diagnosis cancer. They are forced to take chemo too early. Why oncologists force Patients in to treatment so fast ? without knowing the cause without giving the Patient time to digest shocking news without really believing that chemo would help. I think many cancers would heal without poisonous chemo in natural healing ways . I don’t understand how sick body can be healed with application of more poison and radiation Shrinking the tumor and suppressing symptoms doesn’t mean heal it means more problem an death. I think Patient should have control and choice how he is treated and doctor should be only his guide.
No Doctors need NOT have specialized Training .Create a Curriculum for Community Colleges= End of Life Care Specialists.
They can learn to monitor & report to Doctor.
Thus a New Career towards a Team worked Curriculum Approach to inputting info between & amongst Doctors & patients & Communities & Institutions of Care & the varied numerous Religious Denominations .
Visiting a good friend in hospice was an eye opening experience.The staff are incredible, and the care and love overflowing for their terminal Patients is so comforting I saw how far ahead of the hospital they were. They should be funded by Health Care. I do support them in a small way financially.
80 College Street,
Toronto, Ontario, M5G 2E2