title: [Palliative Care: "we have always done it like that!" Problems and experience in palliative care from the point of view of an internist].
abstract: The article shows which patients are in need of palliative care, what the objectives are and that medical care, at the place of the patient's own choice, should be provided. The structures of palliative care in Switzerland and in the region of Schwyz are presented and explained in detail. The difficulties of the financial aspects of palliative care patients in the DRG-system are pointed out. Furthermore, focus is put on the different problems of palliative care from a hospital doctor's point of view. These are, funding, politics, chirurgical colleagues at the hospital, misjudgment of capabilities and capacities of all people involved in palliative care (doctors and nursing staff in and as well as out of a hospital setting), their lack of knowledge in the treatment of symptoms, insufficient communication and coordination of the care-staff of various professions, no guarantee of complete twenty-four-hour care of patients and the lack of standardization in the final phase of terminal care according to the guidelines of Liverpool Care Pathway in all institutions and at home.
authors.affiliation: Medizinische Klinik, Spital Schwyz. goessi.urs@bluewin.ch
authors.forename: Urs
authors.initials: U
authors.lastname: Gössi
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003299:Cooperative Behavior; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D003953:Diagnosis-Related Groups / Q000191:economics; D005380:Financing, Government / Q000191:economics; D006801:Humans; D033183:Interdisciplinary Communication; D007388:Internal Medicine / Q000191:economics; D008505:Medical Staff, Hospital / Q000191:economics; D009313:National Health Programs / Q000191:economics; D010166:Palliative Care / Q000191:economics / Q000458:organization & administration*; D010348:Patient Care Team; D019555:Physician-Nurse Relations; D012931:Social Environment; D013557:Switzerland