Canadian family physician Médecin de famille canadien
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To document the number and pattern of psychiatric and psychosocial referrals to community resources by family physicians (FPs) and to determine whether referral practices correlate with physician variables. ⋯ Family physicians in Hamilton-Wentworth made few referrals to psychiatric and psychosocial services. Only physician sex and year of graduation correlated significantly with numbers of referrals made. Recent graduates of both sexes made significantly more referrals to psychiatric clinics and counseling services than their older colleagues.
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Where there are clear clinical indications that a patient suffering from a terminal illness would not benefit from cardiopulmonary resuscitation, there is no legal or ethical requirement that CPR be discussed with the patient as a treatment option or that CPR be administered if the patient stops breathing or suffers cardiac arrest.
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Talking with dying patients is different in some ways from talking with patients who do not have life-threatening illness; it can be frightening for physicians who have little experience. It is important to realize that, ultimately, the principles remain the same, and that the differences arise in the context and goals of the intervention. This article draws upon bedside experience to define several principles useful in talking with dying patients. Case examples illustrate each principle.