Although lifespans have been increasing, so has the burden of chronic disease. When a person is diagnosed with a serious illness such as cancer, cirrhosis, kidney disease, heart failure or Parkinson's, medical science may not have a cure. But doctors shouldn't say, there's nothing more we can do. Instead, they should ask, how can we help this patient live better, if not longer? That is the goal of palliative care.
Many people imagine that palliative care is strictly for the very end of life. But they are underestimating its usefulness in so many other situations. Helping patients focus on what is most important to them can help them live better, whether their prognosis is for a few months or for a number of years. When expected life span is limited, it may make sense for doctors to discontinue drugs that are intended to help keep patients healthy in the long run and to maintain the medicines that help people feel better, including pain medications.
Many people presented with a frightening diagnosis want to know how long they can expect to live, as well as what symptoms to anticipate. Dr. Pantilat urges patients to ask questions about this, and to be as explicit as possible. Patients may also need to ask for help achieving their most important goals, such as attending a child's wedding. If doctors are asked explicitly, they may be able to indicate which goals are unrealistic and which might be reached through modifying current plans.
Steven Pantilat, MD, is professor of medicine in the department of medicine at the University of California, San Francisco. He is the Kates-Burnard and Hellman Distinguished Professor in Palliative Care and the founding director of the UCSF Palliative Care Program. In 2007, this program received a Circle of Life Award in recognition of excellence and innovation from the American Hospital Association.