Five most important things I have learnt from Palliative Care, guest blog from Dr Leeroy William

Leeroy is a Palliative Medicine Specialist in Melbourne, who has worked in Palliative Care in the UK, New Zealand and Australia over the last ten years.

5 Most important things I have learnt from Palliative Care:

  1. Holistic care – Medicine has lost sight of the person and their life prior to the consultation, but Palliative Care adjusts our focus to see what matters most to a life compromised by disease. Hopefully Medicine is changing and the physical, psychological, social and spiritual domains of holistic care are being recognised as integral aspects to healthcare in general.
  2. Communication – Consultations should be a conversation and never a script. Palliative Care requires excellent communication skills, but more than this is the desire to improve on every encounter. It can be complicated by non-verbal cues, hidden agendas and silences; defused by listening, humour and touch…but remains a process of continual learning.
  3. Family involvement – Make the family feel part of the clinical team – they know their loved one better than you, so listen and learn about the connected lives before you. Allow them to tell you stories about the person – you’ll gain an invaluable sense of who they really are and provide an opportunity for them to reminisce and bring meaning to life.
  4. Human connection – Although we often see people for a fleeting moment in their lives, we also have only one chance to make a difference to that life and their family’s lives. Medicine has much to offer, but “quality of life” is a variable commodity, changing with a joke, hearing a song, seeing a picture, or the mere act of human kindness. Being present often matters most and if the moment moves you, it was meant to – just like your favourite films move you to laughter, tears or fear. People know what lies ahead of them and they deserve your humanity and presence.
  5. Human spirit – I am continually humbled by the spirit of those whom I have met. It has been a privilege to be part of such a personal time for them and their families. They have made me the doctor I am and made me reflect on the person I am. To make a difference to someone’s health is what Medicine is about; to make a difference to someone’s life is what living is about.

If Palliative care was truly “everyone’s business” in Australia what would that look like and what difference would that make?

If Palliative Care was “Everyone’s Business” then all dying patients would be cared for in the venue of their choice, as documented in their advance care plan. Patients and their families would be better informed and prepared via the excellent communication skills of the healthcare professionals involved in their care. Communities would work together to support those dying at home, and/ or their carers. Aged-care facilities would be better staffed and funded to provide holistic care. Medical teams would incorporate holistic care as standard care and the transitions between primary and secondary care would be smooth. Palliative Care would be viewed as the fundamental platform upon which healthcare is built – from education through to clinical services. Palliative Care would be recognised for symptom control as well as end-of-life-care. Everyone would be better informed about death and dying, as well as the distinction that separates euthanasia from Palliative Care.

The above would connect us all to our neighbours and rebuild our communities. Our open discussions would allow more informed decisions to be made around healthcare. Dying would regain an important role in our communities to remind us of the fragility of life and the importance of living, as well as the human capacity for kindness, humility and respect.

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National Palliative Care Week runs from May 19 to 25th and is an initiative of Palliative Care Australia.
Join the discussion by blogging or adding your 5 things!
Read the other contributions -
Molly ‘the Deathtalker” Carlile’s blog here
Rohan Jones here
Peta Murray here
Dr John Rosenberg here

5 comments to Five most important things I have learnt from Palliative Care, guest blog from Dr Leeroy William

  • I am glad the Australian government is taking a step towards improving the palliative care services for Australians, but I think that we are still a while off seeing this type of care ‘as everyone’s business’. Many people have not come into contact with it and until I entered aged care, I had little involvement myself. It is such an important issue/topic for the nation to support as a whole.

  • Hi Sandy-Joan, thanks for your comments! I think we might be a while off yet too – but I totally agree it IS an important issue for the nation to support as a whole! Imagine if we did. cheers kerrie.

  • Dear Sandy-Joan,

    Thank you for your comments. Agree with both Kerrie and yourself with the current status. Education is the key for both healthcare professionals and the general public. I feel however that the power of the patient/ family voice is being heard and things may change quicker from a national and international perspective.

    Until then, we shall continue to advocate and influence change with our clinical, educational and strategic work.
    Thanks,
    Leeroy

  • Dennis Pacl

    Hi Leeroy – It’s hard to know where to start with the culture of healthcare as it stands. If the medical model doesn’t value the importance of empathic curiosity and shared decision-making, then we’ll “make them (patients) Palliative” for a long time to come. It is the hospital culture that does the teaching, and the undoing of empathy and compassion in our students and junior doctors. I’ve been increasingly frustrated with the hidden curriculum, which erodes professionalism and humanism. Those five things you describe are not and should not be exclusive to palliative care education, but other than a few exposures in medical school, most physician trainees will not see those principles revered and modeled by many other specialties, except perhaps, Geriatrics. I know I sound like an old fart, but it was no different back in the late eighties when I started my training. I keep trying to catch students in the act of empathy and emcouraging the behavior. It helps them see that they have something special to offer beyond clinical competence.

  • Hi Dennis – Thanks you for your comments. I do believe Palliative Care should be the “bread and butter” of all healthcare professionals and so my comments I guess speak to this. Treatment for all conditions has its ups and downs and the ability to meet people in that space is vital. We plug away at education and are marginalised for all sorts of reasons, but social media has opened up the space for people to speak up in a revolutionary way. All in all, the best doctors realise the importance of the doctor-patient relationship and that they are often the Medicine!

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