Derek Doyle

Education in palliative medicine.

correct observed deficiencies in care, not because of the emergence of a new body of knowledge and therapeutic possibilities. Unlike other specialties it is not concerned with facts and skills needed by a few practitioners but those needed by every doctor, whether generalist or specialist, reminding us that palliative care is the right of every patient, its provision the responsibility of every doctor. The specialty was created to focus down on this fact, to gain professional credibility, to encourage research and appropriate professional education and to produce a small but important cadre of doctors who could be expected to have a deep and comprehensive knowledge of, and clinical skills in, this small discipline of immense importance. Only a few patients may ever need the technical skills of a surgeon or the prescriptions of an oncologist. All may one day need palliative care, for dying and death await us all. It follows that education in palliative medicine is, like the specialty itself, unique in its challenge. What led to these deficiencies in care which

Efficiency versus compassion in the National Health Service

Address for correspondence: Miss, M Hockley, Palliative Care Team, St Bartholomew’s Hospital, West Smithfield, London EC1A 7BE, UK. Medical audit is expected to play an increasingly important role in the management of health care services. In a recent editorial, Dr Ford outlined the principles for developing audit tools in palliative care.’ Her comments are particularly timely because a variety of audit measures to improve efficiency and thereby save money are already adversely affecting the care of the dying in acute hospitals. In a recent paper2 we drew attention to the distress of terminally ill cancer patients who were forced to transfer to a hospice against their choice. Inappropriate home discharge can also

Autopsy in palliative medicine.

are gaps in our current knowledge; we need to know if the perceived GI benefit of a COX-2 inhibitor+ aspirin + a proton pump inhibitor (PPI) outweighs the risk of a CV event from this combination, or indeed the GI risk associated with a NSAID+PPI + aspirin. In addition, we also need to further understand the CV implications of NSAID + aspirin +PPI. Until such evidence is available, we have to rely upon judicious extrapolation, interpretation and value judgement. As a final thought: Medical practitioners should regard the recommendations of consensus development conferences as useful reference tools; not the rulings of philosopher kings, but the attempt of thoughtful people to share their knowledge albeit imperfect with other people.13