Developing primary palliative care
http://www.100md.com
《英国医生杂志》
EDITOR—To say that general practitioners should be in the front line to provide palliative care, as Murray et al say in their editorial,1 is to misunderstand totally the changed role of general practice in primary care. From today most general practitioners in the United Kingdom will have given up their commitment out of hours, and the health boards must have made alternative on call arrangements.
General practice is responsible for 25% of the week's on-call; the other 75% is being covered by the new out of hours organisations. Between 6 00 pm on a Friday and 8 00 am on a Monday there are 62 hours of out of hours cover. A lot can happen in 62 hours.
A patient's general practitioner can be involved in setting up a care plan and can pass that information on to the out of hours service, but it is no longer possible for most general practitioners to be involved personally, or as a practice, in the out of hours provision of that care.
I have seen how complex some palliative care can become. At times, front rooms resemble intensive treatment units, with the amount of equipment and pharmacology that patients need to be kept comfortable in their own home. One really has to question the sense of bringing the hospice into the house.
If more patients are to be given the right to die with dignity at home then resources will have to be increased. Specialist palliative care nurses should be given more autonomy, with an increase in their prescribing powers so as to avoid the current nonsense where out of hours doctors must drive to a patient's house just to sign forms such as the authorisation for an increase in syringe driver rates.
Colin I Guthrie, general practitioner
1448 Dumbarton Road, Glasgow G14 9DW Grey_triken@hotmail.com
Competing interests: None declared.
References
Murray SA, Boyd K, Sheikh A, Thomas K, Higginson IJ. Developing primary palliative care. BMJ 2004;329: 1056-7. (6 November.)
General practice is responsible for 25% of the week's on-call; the other 75% is being covered by the new out of hours organisations. Between 6 00 pm on a Friday and 8 00 am on a Monday there are 62 hours of out of hours cover. A lot can happen in 62 hours.
A patient's general practitioner can be involved in setting up a care plan and can pass that information on to the out of hours service, but it is no longer possible for most general practitioners to be involved personally, or as a practice, in the out of hours provision of that care.
I have seen how complex some palliative care can become. At times, front rooms resemble intensive treatment units, with the amount of equipment and pharmacology that patients need to be kept comfortable in their own home. One really has to question the sense of bringing the hospice into the house.
If more patients are to be given the right to die with dignity at home then resources will have to be increased. Specialist palliative care nurses should be given more autonomy, with an increase in their prescribing powers so as to avoid the current nonsense where out of hours doctors must drive to a patient's house just to sign forms such as the authorisation for an increase in syringe driver rates.
Colin I Guthrie, general practitioner
1448 Dumbarton Road, Glasgow G14 9DW Grey_triken@hotmail.com
Competing interests: None declared.
References
Murray SA, Boyd K, Sheikh A, Thomas K, Higginson IJ. Developing primary palliative care. BMJ 2004;329: 1056-7. (6 November.)