Palliative care can help improve your quality of life if you have a serious - often chronic - illness. Last week's column explained how to organize your thoughts and feelings to explain what you are looking for from palliative care. But how do you even find and get a referral to a palliative care specialist (who may be a doctor, nurse practitioner, or social worker focusing on palliative care)?

It is reasonable to ask your primary care physician for a referral. But suppose your doctor says something like, "Oh, you don't need to see a specialist. I'm already doing palliative care - I gave you a prescription for sleeping pills/pain pills." In that case, you might propose that you get a second opinion from a palliative care specialist to help with quality of life issues and limitations on your ability to function that any primary care practitioner simply may not have the time to address.

Two local palliative care specialists, both board-certified by the national organization that credentials physicians in this field, are Dr. Sam Downing of Good Samaritan Home Health & Hospice and Dr. Kevin Doyle of Granite Mountain Home Care and Hospice. (While all hospice care is intended to be palliative, palliative care can also be extremely useful for any individuals experiencing serious chronic conditions regardless of their age or how long they are expected to live -- which may be many decades. Palliative care can also help their families.)

Dr. Doyle explained, "Usually, people are referred to a palliative care specialist by their physician. But this referral can be patient-driven: just ask! If the patient doesn't have a primary care physician, but their family feels that they would benefit from a consultation, they can request one directly. But we don't want to get in the way of the patient's relationship with a primary care doctor, which is why we prefer to get a referral. Particularly with pain, a lot of primary care doctors are hoping I'll take over."

Dr. Downing observed, "There is still some resistance to getting palliative care based on culture, or based on philosophical beliefs about the nature of medicine. If people believe that the physician tells you what to do and you do it, then oftentimes patients are reluctant to ask for anything else." However, as more people become aware of the benefits palliative care can offer in improved quality of life and functionality, it is likely that more people will start asking for such referrals.

He noted, "In the same way that you might go in and say, 'My hip hurts and I would like to see an orthopedic doctor,' we are now at a time when you can go in and say, 'I have all this chronic pain or all these chronic problems that I need to deal with, is there a palliative approach or is there a palliative doctor that I could see?'"

How do you find a palliative care practitioner?

The American Academy of Hospice and Palliative Medicine has a doctor listing, but the site requires jumping through some hoops. To save you the trouble, I note that Dr. Downing and Dr. Doyle are the only two board-certified palliative care doctors listed as practicing in Prescott. If you are interested in doctors elsewhere, a link to a site that allow searching for physicians certified in palliative care can be found at www.palliativedoctors.org/resources/find-a-hospice-a-palliative-medicine....

Doctors, nurses and other healthcare providers historically have often delivered care that has elements that are palliative. However, the field has been recognized as a specialty meriting its own training and certification only since 2006. As a result, Dr. Downing noted, to find a provider, "At this point, you are not going to find a listing in the Yellow Pages. You may in the future. But at this point we don't have any palliative care clinics here. People can talk to their primary care provider. The referral doesn't have to be to a doctor. Nurse practitioners can do wonderful palliative care. Physicians' assistants, well-trained, can do excellent palliative care."

Next week's column discusses where palliative care is offered, and provides more information about consultations.