I’m trying hard to teach physicians what the mission guidelines for hospice and palliative care are. It’s very difficult. They are taught to extend a few more days, few more breath’s and we’re trying tell them to make them comfortable. They need to know that the goals of care will change as people are getting worse. Towards the end of life if you don’t send them to Hospice care earlier they’re going to have a bad death. I suggest that we should use every media there is to teach them. They need to learn guidelines for prognosis and how to prognosticate a terminally ill patient. They need to realize that some of the patients were getting worse and they cannot provide any more treatment and they send them to Specialist and they cannot provide any care. Those are the patients they need to think of sending them to Hospice. We need to do teach them admission guidelines which include PPS, ADL descriptive scale, NYHA criteria and ECOG scale. We need to teach them Dyspnea scale also. We need to teach them the FAST scale also. In addition to that we need to teach them admission guidelines for each disease process such as cardiac respiratory neurological malignancy renal and diabetes. if they learn the basic skills regarding their skills and the admissions Guidelines they will be able to send the patients early and not have bad deaths. My thing is to teach them end-of-life care that is very very important for the physician to learn.

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