Care of the Terminal Patients in the Primary Care : Practice for 5 years and its evaluation(Care of the Dying)

Abstract

On my visit to St. Christopher's Hospice in the suburban London, England in April, 1977,I met and exchanged views with the director, Dr. C. Saunders, who is the leader in the hospice care. I inspected the total care given to patients in the wards deeply impressed. I reflected upon the conditions of the terminal care prevailing in Japan even though the spiritual environment is different in two countries.I think it is a universal desire of a man to accept death at home surrounded by his family if there are no medical problems. Based on this theory, I have tried to give the terminal care with the main emphasis on home care as a medical practitioner responsible for primary care. In case of severe pains, etc. and in case where nursing at home is not quite satisfactory, patients were received in a mini-hospice under my supervision.Among those who visited my hospital during the five years between 1977 and 1981,120 expired; 59 at home (49%), 15 in my hospital (13%), 45 in other hospitals (38%) and 1 outside his house (1%). The ratio between those who died at home and those hospitalized was 1 : 1. In case of patiets with apoplex, more died at home, 21 at home (64%), 4 in my hospital (12%) and 8 in other hospitals (24%). Among those with malignant neoplasm, 16 died at home (30%), 10 in my hospital (19%), and 45 in other hospitals (38%). The main complaints of 25 cancer patients whom I cared till death were : 13 of fatigability and anorexia, 6 of intractable pains, 2 of ascites, 2 of gastrointestinal bleedng, 2 of dyspnea, and 5 of insufficient number of people to look after them. Based on psychosomatic medical care, these terminal patients were given (1) such physical cares as specially prepared diets suitable for ingestion and preventive administration of Brompton Cocktails, and (2) such mental cares as non-verbal communication with patients to relieve their anxiety and loneliness and support their hope as well as physical and mental assistance given to their families who were tired with nursing.The terminal care given by our staff is generally supported and appreciated by the bereaved families.I firmly believe that "care of dying patients" in the primary care should be given at homes, if possible. To achieve this purpose, socialized medicine is essential. The technique to support "clinical medicine for the dying" is one of applying psychosomatic medicine.