I believe I can be a better doctor.
It was very early in my student life when someone very wise pointed out to me that doctors don’t save lives – we merely prolong death. Death is inevitable, and if you need some time to reconcile that with yourself and rethink your life priorities, go ahead and take as long as you need – this post will still be here when you get back 🙂
Of course, there is much more to life than inevitable death. In Emergency Medicine and Critical Care we sometimes struggle to retain this level of insight. It’s a strange fact that the days we consider to be our “best”, most interesting or most successful are those where we engage directly in the very human fight for survival. I have to admit that on a personal level the desire to see a patient who is “really sick” doesn’t sit all that comfortably with me, however much that sentiment represents an urge to utilise the knowledge and skills I feel are my strengths on days filled with sprained ankles and paronychia. We deal with death every day in our departments; the patients we lose affect us and drive us to reflect on what we could change, do differently, do better.
It’s no wonder, then, that when we see patients who already know that they are dying – inevitably, and soon – we struggle to change gear.
But there is more to palliative care than managing patients at the end of life. In fact, these are patients for whom we can make a huge difference at an incredibly important time.
Here are a couple of great (and one average!) resources to help you pause and reflect on this rather different, diverse patient group. I cannot emphasise enough the difference you can make to your patients by taking the time to recognise their unique needs and priorities. I reckon you can get through this lot in less than 60 minutes and it will be time well spent, not just for the patients you see who have life-limiting conditions (adult or paediatric), but also their families, carers, and maybe even all your other patients.
Don’t be mistaken – this post is not boring! Brent Thoma from Canada has put together a great little post on the structured approach to the palliative care patient presenting to your ED.
Ashley Shreeve works part time in the ED and part time in palliative care. This great 20min videocast of her lecture on end-of-life care gives some crucial tips on communication with families in end-of-life conversations.
Let’s bust some myths right now: palliative care patients in the ED aren’t all old, don’t all have cancer and aren’t all dying. There are some specific conditions and presentations which are more likely to occur in patients with terminal disease and the approach we take to treating them may be different from other patients. In this 6-minute 40-second PK talk I made for SMACC I take you on a whirlwind tour of some common palliative care emergencies and their management.
Wednesday 13th March 2013 was NHS Change Day, a day when NHS staff and supporters pledged to make a change to improve care for patients, their families and carers. It’s not too late to make a pledge. If you haven’t already, commit now to investing your time in the resources above – find out where your local hospice is, find out how to get help and advice from your local palliative care and pain teams, and make a pledge to ask your patients; “What is most important for you, right now?”
I believe I can be a better doctor – and I believe you can too.
As a very junior doctor I worked for 4 months at St Ann’s Hospice where I have to credit the fantastic staff (and patients) who taught me so much about the value of dignity, respect and true quality of life. Before medical school I volunteered at my local hospice and during medical school at my local children’s hospice which has more emphasis on respite than palliation (the inverse is true of the adult hospice movement). I mention these fantastic places not only to credit the incredibly important work they do for patients and their families but also as a reminder that both adult and children’s hospices in the UK receive only a small proportion of their funding from the government – so if you are looking for a worthy cause for your next marathon..!