The “abandonment” of palliative care patients

Palliative care is an emotionally charged area in which to practise medicine. Families and loved ones are often overwhelmed by their situation and may be as in need of a physician’s patience, empathy and attention as the patient.

The College sometimes receives calls from family physicians and physicians working with palliative care teams with questions about their joint involvement with a patient’s care. Two of the most common questions are:

  1. Should the involvement of a palliative care team mean that the family physician withdraws his/her care of the patient and family?
  2. Should the family physician continue to prescribe narcotics to a patient who has moved into a hospice or palliative care ward or is now under the care of a palliative care team?

Palliative care teams may provide care to many patients across several facilities or at home. This may mean that the palliative care physician is not able to assume the role of the family physician. However, the role and scope of the palliative care team or palliative care physician may differ depending on the location.

The family physician may have provided care to the patient over a period of time and be aware of his/her other medical conditions, as well as have a rapport with the family. On an emotional level, the patient and his/her family may feel abandoned if the family physician automatically or abruptly withdraws from involvement in the care. This can add to the stress of an already difficult situation.

Transfer of patient care to a palliative care physician or team may be appropriate and should be done, as with all transfers of patient care, in a professional, collegial manner and always after direct communication between the physicians involved. This should be followed by clear communication with the family as to where the medical responsibility for the patient’s care now rests.

Different palliative care programs have different policies and resources. Some have the capacity to assume primary care and some do not. It is expected that referring physicians be mindful, where applicable, of the specifics of the program (if any) in which the palliative care physician is working.

Prescribing narcotic medications to a palliative care patient may also be the responsibility of the family physician or the palliative care physician, depending on the circumstances. The patient and the family should never become the victims of the failure of physicians to communicate about prescribing responsibilities.

Citing jurisdictional issues or the guidelines of the College’s Prescription Review Program (which speaks primarily to prescribing for chronic non-cancer pain and not acute or palliative care pain) is not helpful or professional in such situations, and may cause unnecessary distress, and even pain, to palliative care patients and their families.

Reference to generic guidelines on expected standards for referring physicians and consultants can be found at: https://www.cpsbc.ca/files/pdf/PSG-Expectations-of-the-Relationship-Between-Physicians.pdf