Abstract
What is medicine about? “Careful diagnosis, skillful management, effective treatment, and cure” is one version of what most health care providers would reply. When is this paradigm inappropriate? At the end of life. What then defines how the doctor and his or her team approach the patient at the end of life? The guiding principles are those of palliative care. What difference does this approach make? Cure is no longer possible. The end goal changes from cure to comfort. How is comfort defined? Relief from pain and nausea, promotion of sleep and appetite, maintenance of appropriate activity, and management of anxiety and depression provide one operational definition. The patient's mindset becomes a primary concern of the psychiatrist on the Palliative Care Team. Has the patient reconciled key relationships in anticipation of dying? Has the patient completed a life review that validates a life worth living? Is there a level of comfort associated with dying? For the psychiatrist working in palliative care, this set of tasks often qualifies as a new life stage for the patient. There is a group of tasks to identify and master. What is the patient's spiritual understanding of what comes next?
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