IAHPC Board Member’s Page
Must Oncology be our Home?!
Mohammad Zafir Al-Shahri, MBChB, FFCM, ABHPM
Consultant in palliative care medicine in King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia and is an IAHPC Board Member
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Apart from some pioneering medical efforts aiming at better symptom control (pain in particular), the concept of palliative care may owe more to the nursing profession than to medicine. This is not to negate the crucial role of physicians and other professionals in the development and delivery of palliative care. Physicians whose discipline of practice is solely or mainly palliative care come from a variety of specialty backgrounds. Of these, family medicine, internal medicine, anesthesiology and oncology are only a few. Being still an evolving health discipline, no clear demarcation lines have yet been drawn to identify various territories related to palliative care medicine.
The question of what should be the parent specialty for palliative care medicine is valid and perhaps timely, given the increasing number of postgraduate training programs in this field. The other related and equally important question is: where should palliative care medicine be located on the organizational charts of academic and health care institutions. This question may be of a lesser significance in some West European and North American countries were palliative care is more established and recognized. However, the same question may be of greater relevance in other countries where the discipline is still struggling hard to gain recognition and support from professional colleagues and health policy makers. In developing countries, where the tendency of the management styles are too central, a higher level on an organizational chart is likely to imply better access to resources and fewer obstacles in the way of growth and development.
Traditionally, palliative care medicine is often organizationally patronized by oncology with the assumption that most of the referrals to palliative care come from oncologists. This assumption may not be very accurate. Clients of palliative care are often, but not always, cancer patients. Also, cancer patients may be treated at times by surgeons and other non-oncologists. A survey in our setting showed that more than half of the referrals to palliative care were initiated by non-oncologists, though cancer was by far the most prevalent diagnosis. Furthermore, other disciplines may have more valid arguments for claiming the right to be the home for palliative care medicine. Family medicine, for instance, with its holistic nature and focus on both the patient and family as the unit of care, may be a good example. It is my viewpoint that considering palliative care medicine to be by default a subdivision of oncology may lead to hindrance rather than facilitation for the development of the former discipline. This may be especially true in developing countries where palliative care has a long way to go in order to meet the massive unmet needs.
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