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Ideas and Opinions |


The Doctor: For Life and at the End of LifeThe Doctor

Philip A. Pizzo, MD
[+] Article, Author, and Disclosure Information

This article was published online first at www.annals.org on 9 December 2014.

From Stanford University School of Medicine, Stanford, California.

Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-2399.

Requests for Single Reprints: Philip A. Pizzo, MD, Stanford University School of Medicine, Lorry Lokey Research Building, 265 Campus Drive G1078, Stanford, CA 94305; e-mail, ppizzo@stanford.edu.

Author Contributions:Conception and design: P.A. Pizzo.

Analysis and interpretation of the data: P.A. Pizzo.

Drafting of the article: P.A. Pizzo.

Critical revision of the article for important intellectual content: P.A. Pizzo.

Final approval of the article: P.A. Pizzo.

Collection and assembly of data: P.A. Pizzo.

Ann Intern Med. 2015;162(3):228-229. doi:10.7326/M14-2399
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The co-chair of the Institute of Medicine Committee on Approaching Death discusses changes needed in the care of patients approaching death and argues that treating physicians should remain fully present even after their patients enter palliative care or hospice programs.

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Sir Luke Fildes' 1887 portrait The Doctor.

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Basic palliative care skills requires collaboration
Posted on December 9, 2014
Christian T Sinclair MD
University of Kansas Medical Center
Conflict of Interest: I served on the IOM committee with Dr. Pizzo. I am editor of pallimed.org. I serve on the board of the American Academy of Hospice and Palliative Medicine
Thanks for writing this opinion article Phil. You make great points about communication and care for people with serious illness. As a palliative care doctor, I try and make sure to highlight the many ways in which basic palliative care skills are being utilized every day by surgeons, oncologists, internists, family medicine docs and so on. For widespread adoption of basic palliative care skills, I learned long ago, that collaboration and working on understanding your fellow professionals (especially their external and personal challenges), is much better than just mere lectures, or allowing palliative care consult teams to do all of the heavy lifting. I'm happy to see growing signs of collaboration between many specialty societies and hospice and palliative care organizations. We have a lot to learn from each other.
Handing off the patient - Modern Medicine
Posted on January 3, 2015
Joseph Kash
Edward Hospital
Conflict of Interest: None Declared
I share your concerns about handing off the patient and in a sense wiping our hands free as the patient enters a different phase of there life with their illness. I am a medical oncologist. I have noticed a change in the last few years where the hospice programs seem to pressure me to hand the care off to the hospice palliative care doctor. I always have told the patient that hospice will be my eyes and ears but I will still be the captain of the ship. I now feel like this is a lie. Hospice services in my area don't seem to want me involved anymore. It most certainly must have to do with changes in reimbursement and wanting to control the utilization of the palliative care.

I am very concerned that my training that stressed continuity has been abandoned. We now hand the patient off to hospitalist when they are sick and to hospice when they are dying. Two times when it would seem that continuity would be most important.
The Changing Nature of the Last of Life
Posted on February 22, 2015
Joanne Lynn
Altarum Institute, Center for Elder Care and Advanced Illness
Conflict of Interest: None Declared
Most Americans will now die of multiple chronic conditions, with the timing of death being unclear until the last few days. People alive at 65 years of age face nearly three years of self-care disability, with a series of private arrangements and health care supports. It seems that "palliative care" should not mostly be the province of specialists - but should be a highly valued skill of virtually all physicians. And it seems that the comments on the last part of life in Annals should be showing more focus on nursing homes, home care, long-term care financing, continuity for this population, and related topics. The IOM report actually does take this up, but that is not what has made it into the professional or public press.
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