Care of dying patients in hospital

Mills, Melissa; Davies, H. T. O.; Macrae, W. A.

doi:10.1136/bmj.309.6954.583

Cited by 132 publications

(83 citation statements)

References 17 publications

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“…32 In a recent article in the British Medical Journal, Smith explains ' Most doctors have witnessed patients die undignified, soulless, high tech deaths and hoped for something better for themselves and their patients'. 33 Patients dying on the wards are sometimes seen as failure.…”

Section: Approaching Deathmentioning

confidence: 99%

“…Practitioners need to be aware of the many barriers that get in the way of a good death, such as lack of training, their own fears of mortality and past experiences all of which can lead to distancing and isolation of the patient. 32 Care of dying patients should be a priority and social, cultural and spiritual/religious backgrounds of patients should be acknowledged and taken into consideration with care planning.…”

Section: Approaching Deathmentioning

confidence: 99%

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Prostate cancer: palliative care and pain relief

Kaya

Feuer

2004

Prostate Cancer Prostatic Dis

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Section: Approaching Deathmentioning

confidence: 99%

Section: Approaching Deathmentioning

confidence: 99%

Prostate cancer: palliative care and pain relief

Kaya

Feuer

2004

Prostate Cancer Prostatic Dis

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“…105 They can neglect remediable factors contributing to dying patients' discomfort, such as poor oral hygiene, unquenched thirst, difficulty eating, and lack of personal contact. 104 Many tend to undertreat pain related to malignancies and chronic disease 106,107 and underestimate the effects of nursing home residents' pain and depression on their health status. 167,168 Yet not all data show that physicians ignore counseling.…”

Section: Psychosocial Factorsmentioning

confidence: 99%

“…22,30,32,92-96 Deficiences have also been noted in the use of endocarditis prophylaxis 97 ; in the monitoring of blood glucose control, renal function, and lipid levels in individuals with diabetes 98 ; in screening for and recognizing ophthalmic disease in individuals both with and without diabetes 99,100 ; for the management of ulcers (treatment of H pylori), 101 asthma (use of inhaled corticosteroids), 102 AIDSassociated P carinii pneumonia (inappropriate undertreatment), 53 and locoregional breast cancer (use of breast-conserving surgery) 103 ; in the care of the dying (attention to endof-life concerns and remediable suffering), 104,105 and in pain control (dosing of analgesics) 106,107 ; and in the recognition of depression, 108 functional disability 109,110 and other psychosocial stressors. 43,111,112 Moreover, Wigton et al 113 surveyed directors of internal medicine programs and found that current residency training does not ensure competency in all the procedures a general internist does in practice.…”

Section: Deficiencies In Management Of Diseasementioning

confidence: 99%

Comparing Generalist and Specialty Care

Donohoe

1998

Arch Intern Med

166

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Policymakers, managed care organizations, medical educators, and the general public are showing an increasing interest in the amount and quality of care provided by generalists and subspecialists. This article reviews studies comparing the knowledge base of and quality of care provided by these 2 groups of physicians. English-language articles were identified through MEDLINE (1966-present) using the following keywords: generalist, generalism, (sub)specialist, (sub)specialty, (sub)specialization, consultation, referral, and quality of care, and through the bibliographies of these citations. All studies were evaluated. With respect to quality of care, only American studies were chosen. Data quality was assessed by me. Evidence is strongest that the knowledge base and quality of care provided by specialists exceeds those of generalists for certain conditions such as myocardial infarction, depression, and acquired immunodeficiency syndrome. Differences in many other areas are multifactorial, and often a function of study design or patient selection. The differences, however, are not as striking or important to the health of the public at large as those deficiencies in disease management, preventive care, and health maintenance that are common to all physicians. Furthermore, overuse of diagnostic and therapeutic modalities by certain specialists leads to increased costs with either no benefit or added risks to patients. The quality and coordination of care provided by generalists and specialists may be improved through changes in education and training, via quality improvement methods of providing patient care, and by increasing visit length and optimizing use of referrals and strategies for generalist-specialist comanagement. Further study of these areas is warranted and should concentrate on outcomes.Arch Intern Med. 1998;158:1596-1608 This article evaluates the amount and quality of care provided by generalists and specialists, a subject of increasing interest to medical educators, managed care organizations, and the general public. Weaknesses in the knowledge base of practicing physicians are reviewed, and investigations attempting to compare generalist and specialty care for common conditions are described. While some of the differences in quality of care may be due to generalists' knowledge deficits, many are secondary to system factors and most are remediable. Furthermore, disparities between generalist and specialty care likely have less impact on the population's health than the deficiencies all physicians share. After discussing the nature of these deficiencies, I explain how they might be corrected and how generalists and specialists can work together, building on their respective strengths, to improve the quality of health care in this country.

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“…EDITOR,—Mina Mills and colleagues' descriptive analysis of the care of dying patients in four Scottish teaching hospitals highlights an area of medical ignorance or avoidance that still exists 11 years after the study 1. I believe that there are several reasons for this.…”

mentioning

confidence: 99%

Why care of the dying is still poor

Blackburn¹

1994

BMJ

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Care of dying patients in hospital

Cited by 132 publications

References 17 publications

Prostate cancer: palliative care and pain relief

Prostate cancer: palliative care and pain relief

Comparing Generalist and Specialty Care

Why care of the dying is still poor

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