Rebuttal: Should palliative care be a specialty?

I thank Dr Vinay for his eloquent and impassioned argument for keeping palliative care as a core part of family medicine. I agree wholeheartedly that palliative care really is just good family medicine and that family physicians are ideally suited to providing this care.

Like Dr Vinay, I too think that we train solid consultant-level physicians with 1-year programs. The question must be, How do we improve management of patients who require palliative care in Canada?

Historically, the creation of a specialty has been good for patients served by that specialty. Heart disease, mental health, and perinatal care are all part of family medicine’s “core business,” but no one could seriously argue that patients’ health is worse off because cardiology, psychiatry, and obstetrics are specialties.

Contrary views boil down to 1 of 3 arguments: it will be bad for patients, it will be bad for health care providers, or the benefits will not be worth the costs. Dr Vinay makes no such contentions. Dr Vinay’s thesis—palliative care is integral to family medicine—is true, but it is not an argument against palliative medicine having specialty recognition.

Dr Vinay is also correct that it would be different from other specialties, but again this is not an argument against its recognition. As family physicians, we must be at the centre of this new specialty, while recognizing that there are other specialists as committed to the whole-patient, family-focused, patient-centred approach as we are.

If our goal is to make things better, we cannot simply embrace the status quo.

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