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Generalist vs Specialty Palliative Care

I recently came across a paper written by Dr. Jessica Zitter in the Journal of Palliative Medicine, where she proposes creating a new society, the American Society for Patient Centered Physicians (ASPCP). “Its purpose would be to bring together physicians of all specialties whose treatment philosophy prioritizes patient-specific rather than specialty-specific approaches.”  

I thought the idea was brilliant and wanted to share it with our CKN readers, here’s a link:  The American Society for Patient-Centered Physicians.  Dr. Zitter also gave me the opportunity to ask her a few questions about her thoughts on the potential benefits of integrating palliative care education into mainstream medical training. Please take a look and share/comment.
– Karen Irwin, CKN Project Coordinator


JessicaZitterby Jessica Nutik Zitter, MD, MPH


In your opinion, which doctors should ideally be trained in palliative care? Every single one. At least partly. Every physician should be equipped with basic pain management and communication skills, and encouraged to call for help from specialty Palliative Care physicians if needed.  By denying physicians this comprehensive training, we deny young physicians like Rebecca the support and guidance they require in learning how to have difficult conversations with their patients, a skill that every successful physician must acquire.  These skills are part of being a doctor, and if we delegate them only to the field of palliative care medicine, patients will suffer, and so will we.


How do you see palliative care fitting into other branches of medicine at the practical level?  There is new emerging interest in differentiating between primary and specialty palliative care, the implication being that all doctors should be able to deliver some amount of palliative care on their own, and specialty palliative care should be pulled in when that isn’t enough. This is a very different model from what has existed to this point, where Palliative Care specialists have been counted on to do most of the symptom management and difficult discussions for all patients. That is not a sustainable model. There will never be enough palliative care physicians to attend to all of the needs of patients with serious illness.  Moreover, if we delegate all palliative care to this small group of physicians, the implication is that other types of doctors get a pass on treating the patient as a whole instead of a collection of organs or diseases.


In their perspective in the November 2013 issue of the New England Journal of Medicine, Timothy Quill and Amy Abernathy proposed that every branch of medicine define a set of basic palliative skills that would be taught to its trainees.  They believed that by equipping doctors with these basic skills, all patients would benefit. Furthermore, physicians like Rebecca, and so many others, would feel confident in delivering the quality care their patients deserved.


How would patients benefit from this? Every patient would benefit from enhanced communication and management of physical and emotional suffering, particularly those approaching the end of life.  There is currently a very high level of unnecessary suffering in patients with serious illness and palliative care techniques have been proven to significantly reduce this.  When patients are informed about their condition and understand the benefits and the burdens of the various treatments that may be offered, they are empowered to make choices about what type of care they want. They are less likely to be shuttled onto what I call the End-of-Life conveyor belt, where bodies are kept alive using increasing levels of technology or machinery, which cause pain and suffering, usually with no change in outcome.   Additionally, there is more and more data emerging that suggests that patients with many types of serious illness not only live better, but also live longer if they receive palliative care.




Jessica Nutik Zitter practices both Pulmonary and Critical Care as well as Palliative Care medicine at Highland Hospital in Oakland California.   She writes extensively about her experience practicing these two different subspecialties and her work has been published in the New York Times, The San Francisco Chronicle, The Atlantic Monthly, The Huffington Post, the Journal of the American Medical Association, the Journal of Palliative Medicine, and the Journal of Participatory Medicine, among others. She has just completed a book which will be published by Penguin-Random House in early 2017.  She is also featured in the documentary Extremis, which examines the complex terrain of end-of-life medical decision making in the Intensive Care Unit of a public hospital. You can find her at, twitter @jessicazitter, facebook jessicanutikzittermd and linked in Dr. Jessica Nutik Zitter.



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2 Responses to Generalist vs Specialty Palliative Care

  1. Pingback: Generalist vs Specialty Palliative Care – Jessica Zitter M.D.

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