Lessons From The Front Personal Reflections on Palliative Care

1
Lessons From The FrontPersonal Reflections on
Palliative Care

• Dr Andrew Skeels
• Medical Director Palliative Care ACT

2
What is Palliative Care?

• Historical beginnings
• Cicely Saunders
• Origins in Religious Orders
• Anti-Oncology
• Anti-Doctor
• Integration into Public Health
• A Cottage Industry Goes Multi-National
• Palliative Care as a Profession

3
Palliative Care Structure

• Hospice
• Stand alone or integrated
• Community Services
• Nursing or medical based
• GP or specialist led
• In home or outpatient based
• Hospital Consultancy
• Acute Palliative Care Beds
• Role as Cancer Supportive Care Team

4
Reflections On Caring

• Dont get lost in the mechanics of care
• Interactions with patients and their families
• Hear, listen, understand
• Learn to talk to non-medical people
• Dont under-estimate how little knowledge of
  health and the body a very large number of people
  have
• Knowledge of the facts doesnt equate with
  understanding
• Ian Maddocks
• 10 Golden Rules
• What do patients and families want?
• Be aware of the different needs of families and
  patients
• Be aware that the needs change during the course
  of the illness

5
Role Of Palliative Care

• Within Public Health
• Oncology
• Non-cancer patients
• Within the Team
• Is the physicianly model ideal?
• Learn to stand firm
• Incremental improvement is normal even in a
  crisis
• Learn to stay calm
• Listen to others
• Patients and family will rarely tell everything
  they need to say to just 1 person

6
Role Of Palliative Care Physician

• Background
• Change to RACP trained vs previous profession
• Palliative Medicine is becoming homogenised
• Previous experience
• Trainees entering from Basic Training vs late age
  entry
• A lifetime of caring for the dying
• What elements of Palliative Care are domain of
  Palliative Care Physician
• Is dying our domain or are we ultimately role
  models to rest of medical profession
• Probably elements of both, but where is divide

7
Self Reflection

• Is there a palliative care personality?
• You learn most from the things you get wrong
• Try to understand what you get from palliative
  care
• Almost everyone you see will die within a short
  space of time. Why do you want to do it?
• Always bring yourself to patient care

8
Self Care

• High incidence of depression and suicide amongst
  profession
• ??? Burden of work or we bring this with us
• Must seek out support network
• Dont assume anyone outside Palliative Care will
  have any understanding of what we do (even
  partners)
• Need for Compulsory Supervision as with
  Psychiatry and Psychosocial Allied Health
  Professionals
• Must have interests beyond work
• Know if you are in trouble
• Take seriously if you feel you are beginning to
  get too involved emotionally or feeling
  unattached, uncaring or withdrawn from patients
  and their families
• Dont carry work home
• Cant solve all problems
• Take yourself into all patient care situations
  but dont leave yourself there
• Palliative Care is a job not a lifestyle