Ottawa dean left academic world to provide bedside care for the dying
Today, explains Dr. Ina Cummings, director of Dalhousie University's Palliative Care Program and past president of the Canadian Palliative Care Association, more physicians are becoming interested in palliative care and developing skills in the field. A recent conference on palliative care attracted 650 delegates -- only 400 were expected -- and the proportion of physicians was the highest ever, at about 20%.
Cummings says there are two reasons for the surging interest. One is the increasing number of patients with progressive illnesses such as cancer, HIV-disease and end-stage organ failure. The number will continue to increase as the country's demographics change. The second reason is that as palliative care develops as a specialty, more physicians will be aware of what can be done and of the specialty's compelling nature.
Some physicians entering the field chose the challenge while in the latter years of medical practice, but most make the change in mid-career. Cummings suggests there are two forces at work. "Many come from a family practice background, drawn into it from a personal interest in this kind of care. Others have a strong holistic view of medicine, and they recognize a need for this in palliative care."
The specialty clearly benefits from the wealth of life experience brought to it by those physicians. Dr. Balfour Mount, director of the Palliative Care Program at Montreal's Royal Victoria Hospital and one of Canada's pioneers in palliative care, agrees with Cummings' assessment. "Physicians, after the first 2 decades of their career, perhaps in family medicine, will recognize the problems associated with the dying, both emotional and physical." Nonetheless, he points out a discrepancy in Canadian health care. "In the United Kingdom and in Australia and New Zealand there is wider acceptance of [palliative care as] a recognized specialty. Because this brings more job security . . . the young will enter it as a field of choice. This contributes greater energy as well as academic excellence." (Although it meets the criteria for recognition by the Royal College of Physicians and Surgeons of Canada, palliative care has not yet achieved specialty status in Canada.)
Mount also stresses the need for a holistic approach and for a palliative care physician to be interested in more than the biology of disease. He said physicians need to combine competent medical skills with the ability to listen, and to be thoroughly sensitive to every aspect of suffering. This combination is fundamental to the practice of palliative care.
"We die badly in Canada," Mount is convinced, "because 85% of us will die in isolation." He believes that the situation will not improve until medical schools develop a generation of physicians who look beyond disease and see further than diagnosis and therapy.
Development of programs that could redress this imbalance is coming, but slowly. Currently, programs are available in Ottawa, Montreal, Winnipeg, Edmonton and Halifax.