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Journal of Postgraduate Medicine, Vol. 55, No. 1, January-March, 2009, pp. 74-75 Letter Comment on - End of life care: Issues and challenges Singh DP Global Cancer Concern India, 11, Bougain Villaea Marg, DLF Phase-II, Gurgaon-122 002, Haryana Code Number: jp09021 Sir, It was very gratifying to read the editorial "End of Life Care: Issues and Challenges". [1] For a palliative care physician like me, seeing this lucid article in a prestigious mainstream medical journal like the JPGM appears as a glimmer of hope, that this subspecialty is gaining acceptance within the Indian medical fraternity. Although the editorial refers to the scenario in the US, most readers would be pleasantly surprised to learn that there is a small but enthusiastic movement of doctors advocating palliative care in India, with Kerala taking the lead. The Indian Association of Palliative Care has been formed, which publishes the Indian Journal of Palliative Care. The Calicut Medical College has introduced a one week′s compulsory internship in the Pain and Palliative Care Unit. The Institute of Palliative Medicine, as a part of a WHO-sponsored project, offers a Certificate Course and Fellowship in Palliative Medicine. Most metros have non-governmental organizations and some cancer hospitals offering home-based, in-patient and hospice-based palliative care to terminally ill cancer and AIDS patients. Shanti Avedna Sadan has three hospices - in Mumbai, Goa and New Delhi. The All India Institute of Medical Sciences has an Indoor Palliative Care Unit and a Pain and Palliative Clinic at the Dr B.R. Ambedkar Institute Rotary Cancer Hospital at New Delhi. But a lot more needs to be done: from using the term "bed-bound" in place of bedridden, to educating physicians to overcome the rampant "opiophobia" by employing the WHO Analgesic Ladder for pain management, [2] comprehending the concept of "total pain" and improving communication skills so that physicians feel comfortable while disclosing a grave prognosis and showing sensitivity and empathy to the family. The editorial has comprehensively encapsulated most of the principles of Palliative Medicine and has attempted to discuss the most neglected aspect of institutionalized medicine: bereavement counseling. There is no better person to do this than the attending physician and believe me, it is a spiritually enriching experience for all concerned! In my experience, employing these principles with a liberal dose of common sense solves most distressing situations that we encounter in managing terminally ill cancer patients. References
Copyright 2009 - Journal of Postgraduate Medicine |
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