Palliative care is a hugely important area of medicine and I believe more time should be dedicated to training all doctors in the skills required to deliver effective palliative care.
There are many reasons for this, not least because there is huge potential for many doctors to learn and expand their knowledge.
During my time in palliative care I have encountered complexity in a wide variety of forms – patients with complex medical diagnoses, some with conditions I have never seen before (and sometimes conditions my consultants have never seen before).
There are complex management plans including a wide variety of medications I have never prescribed or previously had the confidence or supervision to prescribe. Although my job can be busy at times, there is still significant time to learn both on and off the wards.
Dignified dying makes a difference
One of the frustrations many healthcare professionals in the NHS encounter is the times patients have passed away in an undignified way, or the palliative care team have not been called to see a patient early enough.
I have witnessed several patients die in hospital and felt so frustrated, angry and upset because they are clearly deteriorating and dying but investigations such as blood tests are still being performed with no real benefit or clear reason why.
In palliative care, patients aren't just ‘kept comfortable’, they have the chance to think about their preferred place of care and death. They are given time to think about how they want to break the news to their children and are supported with difficult conversations.
They are made aware of the risks and benefits of further treatments and empowered to make their own decisions.
Dignified dying makes a huge difference to patients and their families and during my time in palliative care I feel I have had the chance to significantly impact on my patients’ and relatives’ lives - and they have also impacted mine greatly.
Death and dying are by no means easy topics to raise and discuss. Working in palliative care has shown me how to have sensitive discussions and, although I have a long way to go, I know that by the end of my placement I will have the confidence to discuss death in a sensitive way. This is a crucial skill for general practice.
I have also recognised how important it is to communicate and draw information from your team. Speaking to nurses, counsellors, psychotherapists and pastoral care teams allows for a deeper understanding of patients and, at times, yourself.
Developing as a doctor
Before starting my placement in palliative care I was apprehensive. I was worried about the emotional strain this rotation would place on me.
However, halfway through I can see that although it can be demanding seeing patients come and go so quickly, I am gaining much more in so many ways than I could have ever imagined. I have gained a lot from forming a connection with a patient; when I can make them laugh and when they tell me I have brightened up their day and they look forward to seeing me.
Working in palliative care has forced me to think more about my own life. I am even more grateful for my health and my support network that helps strengthen me and enables me to help others everyday.
Quality of life
It is so unfortunate that so many trainees have left, and continue to leave, medicine. Things are much harder than they need to be and I also get frustrated with the current climate within the NHS.
However, in community settings such as general practice and palliative care there is still a chance to do what ‘we signed up for’ and actually help people and have a positive impact on their lives. This is not about saving lives but about saving the quality of lives. It is about recognising (and recognising early) that when we can't save a life we can enable a good quality of life for that patient, which helps them - and is something their families will remember and value.
- Dr Baptiste is a ST1 GP trainee in Romford, Essex
More on palliative care training and careers
- 15 minutes with... A palliative medicine consultant (BMJ Careers)
- Royal College of Physicians of Edinburgh. Careers and training advice on paliative care
- Health Careers. Palliative Medicine