All doctors must be ready to provide palliative care

Experts say there is a need and an expectation for primary care physicians to know about providing end-of-life treatment.

By Andis Robeznieks, AMNews staff. May 12, 2003.

People are dying differently from the way they used to, say palliative care experts, but that's just one reason why primary care physicians need to know about end-of-life issues.

Another is that patients expect their regular doctors to treat them and to not pass them off to a specialist.

"Three-quarters of Americans expect their physician to be competent to treat their life-threatening illness," said Arthur R. Derse, MD, director of medical and legal affairs and associate director of the Center for the Study of Bioethics at the Medical College of Wisconsin in Milwaukee. "The first person they turn to won't be the specialist that they don't know. It will be their primary care physician."

Dr. Derse, an emergency physician who is also an attorney, was one of the speakers at Northwestern University's Education for Physicians on Palliative Care training conference held in late April. In addition to meeting patients' expectations for end-of-life palliative care, Dr. Derse said, primary care physicians also need to be able to recognize predictable life-cycle patterns that have developed.

Dr. Derse and other conference speakers said that only about 10% of Americans die a sudden death. The other 90% experience a steady decline in health punctuated by a short "terminal phase" of rapid decline, or have a steady decline with periodic "crisis episodes."

The first pattern is one often experienced by cancer patients, and the second by people with Alzheimer's disease or heart disease, said Linda Emanuel, MD, PhD, director of the Buehler Center on Aging at Northwestern's Feinberg School of Medicine, Chicago.