A clinician's perspective from both sides

I have been working in palliative care for many years and am fortunate to live in a community where access to palliative care for the most part is fantastic.  That being said, and despite being a palliative care clinician, I was never able to access palliative care services for my mother in-law as she was followed by a liver specialist who didn't believe she was an appropriate candidate.  I never was able to advocate for this before she died.  We need to get beyond the debate and stigma and ensure that every individual is automatically connected with a palliative approach to care at the time of diagnosis of a life limiting illness. 

My father-in-law passed away in my home on dialysis - full code with no mention of the p word until he was hospitalized with sepsis under the care of an internist who understood - unfortunately that gave us 1.5 days of palliative care services before he died.  The year prior to that took such a huge toll on my family - it didn't need to be that way - PSW support that was excrutiatingly unreliable (from last minute cancellations or just not showing up to showing up, drinking all our coffee and sleeping because they worked a night shift beforehand) and not enough support and communication to maximize his quality of life and avoid numerous visits back to hospital.  

Thus from the perspective of a community where the services are supposedly 'great', we have a long way to go...we need to fund enough PSWs and provide appropriate remuneration to ensure some ownership and job satisfaction can be achieved AND we need to educate clinicians...make palliative referrals MANDATORY!