Managing chronic diseases

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End of life is more than death

Patrick White, senior lecturer (patrick.white@kcl.ac.uk)

Department of General Practice and Primary Care, Guy's, King's and St Thomas' School of Medicine, King's College London, London SE11 6SP

EDITOR—In advanced, non-malignant, chronic illness, the proximity of death and the inadequacy of treatment to prevent it change the patient's circumstances. Accurate prognosis may be impossible and that also influences the circumstances. Although doctor and patient may know death is approaching, planning is needed for a stage of life that could continue for a year or more. For example, two year survival …