Abstrakt
With the progress of modern medicine, many previously lethal diseases now have become chronic conditions, as pointed out by Macleod [1]. During the prolonged course of illness, medical and social complications accumulate that may erode patients' quality of remaining life, including their psychological well-being ("Often the organ to suffer most is the brain" [1], p. 340).
Macleod questioned the role of psychiatrists in palliative medicine, however, and recommended instead that palliative medicine trainees learn about psychiatry. In response, Strouse [2] wrote that this picture was perhaps "too fatalistic" (p. 1166) and that psychiatrists, on the basis of their experience of laboring at the interface of medicine and psychiatry (e.g., in consultation/liaison work and psycho-oncology), have much to contribute to the field of palliative care.
He pointed out two new forces in favor of greater involvement of psychiatry in palliative care: the expansion of integrated care, of which palliative care is a primary example, and the evolution of the clinical role of the psychiatrist/psycho-oncologist into that of a more fully formed palliative care physician [2]. In 2013, only 58 psychiatrists and 41 neurologists achieved hospice and palliative medicine subspecialty certification in the USA [2].
Fairman and Irwin [3] note that despite the fact that the American Board of Psychiatry and Neurology is one of the 10 boards of the Accreditation Council for Graduate Medical Education (ACGME), only 15 psychiatrists were certified in palliative care fellowships in 2008, 12 in 2010, and 34 in 2012. Although the numbers of board-certified practitioners have been increasing, psychiatry's involvement is woefully inadequate, given the aging of the population and increasing clinical needs.
The reasons for this lack of involvement are multifaceted and far from being adequately investigated.