Palliative Medicine: What Every Internist Ought to Know

Susan B. LeGrand

POINTS TO REMEMBER:

Palliative medicine may be given concurrently with disease-specific therapy.
General internists should be able to provide primary palliative care services with consultation for more complicated care.
There are three fundamental differences from hospice care:
- Life expectancy: Hospice requires a limited life expectancy typically defined by Medicare or other insurances as less than 6 months. Palliative medicine has no such limitations.
- Goals of care: Hospice care neither hastens death nor prolongs life. Palliative medicine is not limited in this way and may actively attempt to prolong life if consistent with the goals and values of the patient and family.
- Funding mechanisms: Hospice care is a specific capitated benefit, whereas there is no specialized funding mechanism for palliative care.
Studies have shown that end-stage cardiac and pulmonary patients are as symptomatic as cancer patients, but there are few studies on specific symptom management.
A morphine infusion is inappropriate care for many dying patients. It should not be used for sedation.
Palliative sedation, the conscious choice to decrease the level of consciousness of a patient is a procedure that requires patient and/or family consent.

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