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NEWS: Susan Mayor Pilot study shows cost effective approach to enable people to die at home BMJ 2008; 336: 912-b-913-b [Full text]

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Preparatory work is all

Graeme Mackenzie   (26 April 2008)

Preparatory work is all 26 April 2008
Graeme Mackenzie, GP out of hours North Cumbria Send response to journal: Re: Preparatory work is all	As an out of hours GP I am often thrown into terminal care situations with no knowledge of the patient. As an experienced GP I can usually tell that "the end is nigh" but that is not the whole story. Then the "politics" starts. Sometimes the family are not aware of how an attending GP might manage this situation. I have to very careful that my treatment decisons are not seen as the main reason life ended. As a relatively annonymous doctor I would be an easy target for misunderstanding. I might admit to hospital if I did not feel I was able to "sell" my home treatment to the family. If the patients own GP prepares the family and patient for the likely events as the end nears, then my job is easier. I am not generalising and families usually are more than happy to continue home management once there is adequate discussion of what is trying to be achieved. Usually families have also been prepared well by the GP and palliatIve care services. However there are occasions where admission is necessary to cover my back as a complaint of ending a life prematurely can have serious affects on professional and personal lives. Competing interests: None declared