Consultation in palliative medicine

Palliative medicine is an emerging medical discipline in the United States, modeled after similar efforts in Great Britain, Australia, and Canada. Increasingly, academic medical centers are starting clinical programs in palliative medicine including inpatient consultation services. A description of the essential components of a palliative medicine consultation is presented, based on the author's experience of more than 600 patient encounters at the Medical College of Wisconsin in Milwaukee. A palliative medicine consultation consists of 6 features: assessment and management of physical symptoms; assisting patients to identify personal goals for end-of-life care; assessment and management of psychological and spiritual needs; assessment of the patient's support system: assessment and communication of estimated prognosis; and assessment of discharge planning issues.