I write in response to the article by Burge et al. in the June 2013 edition of Palliative Medicine entitled “Advance care planning education in pulmonary rehabilitation: A qualitative study exploring participant perspectives.”1 I congratulate the authors on their study and its implications for future quality care improvement, but I also wish to raise the issue of a potential unintended consequence of its implementation. The study included patients with chronic lung disease participating in a pulmonary rehabilitation program. The patients were comfortable with advanced care planning discussions being initiated by non-medical personnel, who had been extensively trained and equipped with the skills to hold these conversations. Participants also valued the fact that discussions took place outside an acute episode of illness. Will a discussion of advanced care planning initiated by appropriately trained non-medical personnel in the context of rehabilitation programs result in a higher quality of care, that is, a significant increase in appropriate end-of-life planning and care, with increased patient and family satisfaction (and even potentially reduced costs)? The answer may well be yes, and that would be an enormously positive outcome. There is evidence that systematic advanced care planning improves end-of-life care from a patient and family perspective.2 Discussions at an early stage reduce aggressive acute care admission at life’s end whilst increasing hospice use in oncology patients.3 However, I would argue that implementing structures that protocolize the task of initiating such discussions to nonphysicians is a slippery slope, and runs the risk of physicians deskilling, or much worse, abnegating their responsibilities in this area. In this era of super-specialization, many doctors appear to see themselves as only being responsible for one segment of a patient’s care. There is evidence that physician– patient discussions are consumed by immediate problems, with minimal dialogue about the future.4 It is telling to see the quoted patient response in Burge et al.: “I don’t think it should be the doctors’ province because they have so much else to do ...” My own experiences include the perception of an increasing expectation that intensivists take responsibility for the initiation of discussions of end-of-life care, as well as the duration and intensity of treatment modalities, for patients who have not yet crossed the threshold of an intensive care unit (ICU). Even after admission, the literature contains two broad views on who should best manage this aspect of care within the ICU: a “consultative” model (using an “external” palliative care team) versus an “integrated” model where palliative care is “embedded” within standard intensive care practice.5 There is, rightly, a global initiative involving both endof-life care guidance statements6 and national quality standards7 to improve the standards of doctor–patient communication, and facilitate patient and family input into medical decision making. It would seem beholden to all doctors who look after patients with life-limiting illness to have the skills, competence and desire to be able to at least contribute meaningfully in this area, in the interests of better quality patient care. In fact, it could be argued that these interactions encompass an absolutely fundamental part of what it means to be a doctor. I hope that when the knowledge gained from this study by Burge et al. is implemented, it is done so as the authors doubtless intended, as a quality patient-centered initiative that adds significantly to the current processes of care. I also hope that it is not seen by some as a means to divert a little more responsibility away from those of us who are not specifically palliative care specialists.