Managing chronic diseases

نویسنده

John Reiss

چکیده

Editor—Palliative care does not start when a patient is dying. A whole spectrum of palliation begins from the day of diagnosis of a potentially terminal disease, such as soft tissue sarcoma. Palliation, in the sense of needing to absorb what this means for the patient, becomes even then a medical imperative. The “How long have I got, Doc?” question may not be articulated, but it will be there and needs an empathetic response. Curative treatment is sought, but—with sarcoma—lung metastases signal the end of that phase and the beginning of palliative treatment. The doctor and the patient know the dragon can be disabled but never slain. Palliation is then partnership, working to decide what may be gained at what cost. (This may apply during curative treatment: to take chemotherapy drugs now “just in case,” or to keep them for later?) Palliative treatment can be long (in sarcoma up to 20 years or more), or it can be brief. Its ending is not solely a medical judgment. Doctors may decide they can do no more, but active patients use online support groups, seeking new treatment options across the world. Patients may decide to end palliative treatment. Grown weary of painful chemotherapy offering diminishing returns, they may prefer a shorter but better life. Making that choice together is an aspect of palliation. When death is near, palliative care becomes terminal care. If throughout doctors and patients have aligned their understanding of the disease, and have taken decisions jointly, have explored the holistic meaning of disease in life and death, the palliative spectrummay offer healing if not cure. If, however, being palliative begins only when the patient is dying doctors cannot then meet patients, where they are most needed, in the ground of their being and their not being.

برای دانلود رایگان متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

COVID-19 in Iran: A model for Crisis Management and Current Experience

In February 2020, the first sample test was confirmed as positive for corona virus in Masih Daneshvari Hospital that is the reference center in Iran for all pulmonary and respiratory diseases. The decisions made in a hospital or organization to manage a crisis is very vital. Success in managing any crisis requires a scientific and scholarly attitude. This paper was distilled from experiences ga...

متن کامل

COVID-19 in Iran: A model for Crisis Management and Current Experience

متن کامل

Updated guidelines for managing chronic kidney disease.

Chronic kidney disease (CKD) is the most costly disease covered by Medicare, and two common causes of CKD, diabetes and hypertension, are increasing worldwide. More than 60% of Americans will develop CKD in their lifetimes. This article reviews updated guidelines for managing CKD in primary care.

متن کامل

managing the cardiovascular complications of chronic kidney disease

Patients with chronic kidney disease have risk factors for cardiovascular disease which are additional to those found in the general population. many patients will die of cardiovascular disease before they require dialysis for their kidney disease. While lifestyle modification is essential, it is important to manage the patient's anaemia, dyslipidaemia and hypertension. managing heart failure c...

متن کامل

I-18: The Ethics of Managing Extremely Premature Neonates(EPRN) between 22-24 Weeks

When faced with a preterm delivery of an extremely premature neonate between 22-24 weeks (EPRN), doctors are confronted by a three-fold uncertainty of age, viability and prognosis that influence their decision whether or not to resuscitate the neonate. Firstly, in the delivery room the preterm neonate’s age is seldom precisely known, and successful resuscitation depends on the neonate’s accurat...

متن کامل