TY - JOUR T1 - The continuing challenge of palliative care JF - British Journal of General Practice JO - Br J Gen Pract SP - 3 LP - 4 VL - 56 IS - 522 AU - Ilora Finlay Y1 - 2006/01/01 UR - http://bjgp.org/content/56/522/3.abstract N2 - Palliative care, unlike many other specialties, has many of its roots in primary and community care. Cicely Saunders' original vision on her pioneering journey to establish hospices and hospice care worldwide, was primarily to ensure that excellent care relieved patients' suffering as they approached death. She coined the term ‘total pain’ to express the overwhelming feelings of pain and despair that occur when physical pain is compounded by emotional anguish, social concerns and isolation, and spiritual turmoil. She also drew attention to a patient's need to feel confident that the professionals are committed to providing care, valuing the individual patient, and above all, not abandoning the patient in their hour of greatest need, whenever that is. Such a personal relationship was seen in the traditional family doctor role, but the establishment of the hospice movement brought the science of palliative care into the frame.Now the new GP contract has radically altered the work-patterns of GPs, and hence the service that the patients can expect. There are advantages and disadvantages for both parties in the new relationship. However, for terminally ill patients, the disadvantages are thrust into view. A recent study by the Parkinson's Disease Society, Just Invisible: the Advanced Parkinson's Project, makes stark reading.1 For so many patients with advanced disease, their carers bear the brunt at nights and weekends, becoming exasperated and exhausted, with the patient dependent and feeling ashamed but helpless in the face of bladder and bowel problems. Sleep deprived relatives struggle, with limited carer input. Few have been properly taught to lift and turn the person they love. As death approaches, so fears increase, yet relatives providing care at home hesitate to call for help. When they do call, … ER -