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Rebuttal: Should palliative care be a specialty?: YES

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Canadian Family PhysicianLe Médecin de famille canadien Vol 54:  july • juillet 2008

Debates

I 

thank Dr Vinay for his eloquent and impassioned argu- ment  for  keeping  palliative  care  as  a  core  part  of  fam- ily  medicine.  I  agree  wholeheartedly  that  palliative  care  really is just good family medicine and that family physi- cians are ideally suited to providing this care.

Like Dr Vinay, I too think that we train solid consultant-  level  physicians  with  1-year  programs.  The  question  must  be,  How  do  we  improve  management  of  patients  who require palliative care in Canada?

Historically, the creation of a specialty has been good  for patients served by that specialty. Heart disease, men- tal health, and perinatal care are all part of family medi- cine’s “core business,” but no one could seriously argue  that  patients’  health  is  worse  off  because  cardiology,  psychiatry, and obstetrics are specialties.

Contrary views boil down to 1 of 3 arguments: it will  be bad for patients, it will be bad for health care provid- ers, or the benefits will not be worth the costs. Dr Vinay  makes  no  such  contentions.  Dr  Vinay’s  thesis—pallia- tive care is integral to family medicine—is true, but it is  not an argument against palliative medicine having spe- cialty recognition.

Dr Vinay is also correct that it would be different from  other specialties, but again this is not an argument against  its  recognition.  As  family  physicians,  we  must  be  at  the  centre of this new specialty, while recognizing that there  are  other  specialists  as  committed  to  the  whole-patient,  family-focused, patient-centred approach as we are.

If our goal is to make things better, we cannot simply  embrace the status quo. 

Dr Shadd is an Assistant Professor in the departments of medicine, family medicine, and oncology at Queen’s University in Kingston, Ont.

Competing interests None declared

Correspondence to: Dr Joshua Shadd, 34 Barrie St, Kingston, ON K7L 3J7; telephone 613 548-2485;

fax 613 548-2436; e-mail shaddj@kgh.kari.net

These rebuttals are responses from the authors of the debates in the June issue (Can Fam Physician 2008;54:840-3).

YES

Joshua Shadd

MD CCFP

Rebuttal: Should palliative care be a specialty?

C

learly,  palliative  care  could  become  a  specialty  or,  as Dr Shadd has proposed, a subspecialty of family  medicine. The real question is, Should it become a spe- cialty? And will this generate a benefit of some sort? Will  it help disseminate a relevant palliative approach across  Canada?  Will  it  engender  immediate  training  for  fam- ily physicians in this area? Our first social objective is to  enable  all  of  our  citizens  approaching  the  end  of  their  lives to benefit from the palliative approach as quickly as  possible, regardless of where they live. 

Before  we  create  a  subspecialty  that  would  reduce  the  number  of  people  who  actually  deliver  palliative  care  (as  we  would  quickly  rely  exclusively  on  those  accredited to deliver this care), should we not enhance  the  training  and  involvement  of  all  family  physicians? 

Family  physicians  work  across  a  vast  area,  and  there  will never be enough subspecialists to meet the needs  of  patients.  Do  family  physicians  understand  the  urgency of trying to fill this need? Have all our faculties  of  medicine  incorporated  adequate  training  in  pallia- tive  medicine  into  their  curriculums?  Have  they  dem- onstrated  the  conviction  that  all  physicians  should  be  comfortable with the palliative approach, regardless of  their  field  of  practice?  As  a  society,  we  already  have  a  tendency to solve problems by changing our structures  and  making  them  even  more  complex.  What  we  need  to  do  here  is  trust  the  excellent  practitioners  we  are  training and help them to take up this challenge. When  we  have  done  that,  we  can  talk  about  creating  a  sub- specialty. But will we still need one? 

Dr Vinay is a member of the Palliative Care Department of the Centre hospitalier de l’Université de Montréal at the Hôpital Notre-Dame and the Université de Montréal in Quebec.

Competing interests None declared

Correspondence to: Dr Patrick Vinay, 2950 Soissons Ave, Montreal, QC H3S 1W2; telephone 514 344-9479;

fax 514 344-3792; e-mail patrick.vinay@videotron.ca

NO

Patrick Vinay

MD

Cet article se trouve aussi en français à la page 976. Cet article se trouve aussi en français à la page 977.

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