After training and working in palliative care in the United States, David Butler is impressed with how New Zealand provides the same service. Eileen Goodwin reports.
Care is much less fragmented and patients enjoy long-standing relationships with family GPs, Otago Community Hospice's clinical leader David Butler says.
"Palliative care is integrated into the acute care system in a more thoughtful way [in New Zealand].''
Dr Butler (53) moved to Dunedin in December with his wife Kristi and two sons.
Drawn by an attraction to "medium-sized college towns'', Dr Butler relinquished a role as executive medical director at a large not-for-profit hospice in Phoenix, Arizona.
He spent two decades in Arizona but is originally from Iowa, in the Upper Midwest, and was raised in a town of just 500 people.
He enjoys Dunedin's temperate climate after summer days of about 45degC in the desert-climate city.
"Different euphemisms'' and slang take a bit of getting used to in a role involving delicate conversations. Good communication forms a large part of palliative care, he says.
Some things are the same, he says, such as the reticence in Western societies to speak about death.
Another thorny topic in both countries is euthanasia, and on that, Dr Butler says he can construct cogent arguments both for and against.
It is not unusual to be asked by patients about hastening the process.
"Whenever you are asked that question, you are obligated as a clinician to peel that onion back and [find out] what it is that makes them ask the question.
"[Mostly] you can get to the bottom of what it is they are fearing or concerned about, and provide some support for whatever that is.''
The euthanasia debate will be around for some time, he believes, driven by the public rather than the medical community.
"This is going to be swayed by the populace; it's going to be decided in the court of public opinion.''
There is the same challenge in New Zealand to educate the public about palliative care and many people do not know it is based mostly in the community.
Only 3% of care at Otago Community Hospice is delivered in its inpatient unit, he points out.
"Palliative care still is kind of mystified.''
