Palliative care boom

As Australia’s population ages, the profile and importance of palliative care is set to grow significantly, and GPs will often be the ones patients call upon to deliver it.

• Palliative care not a standard part of GP registrar training
• Six-month specialist skills posts offer training and insight in this area
• Online resources available to help GP registrars develop skills in end-of-life care

EVERYONE dies – that’s an indisputable fact of life. Beyond this fact, however, many questions are now being asked about the quality of death, and who should guide us and care for us during our final days.

Palliative care – the art of caring for someone with a progressive, life-ending illness – has always been in the domain of GPs, and increasingly registrars are seeing the value in cultivating specialist skills in this area.

DAUNTING AND REWARDING

Dr Jennifer Mooi - former RACGP Registrar of the Year - completed a special skills post in palliative care.

While Dr Mooi is the first to admit working in palliative care can be daunting, she hastens to add it is also immensely satisfying, and offers doctors an opportunity to draw together all elements of their medical training.

“You’re not able to change the outcome... You accept [the patients] are going to die, but as a doctor you’re able to make that quality of life greater to the end,” she says.

“You’re providing a great service to them, and their family are so appreciative.”

Dr Mooi says entering into palliative care and general practice later in her medical career – in her sixth and seventh year – may have helped her handle the very emotional side of the specialty.

But despite that the work has been emotionally draining at times.

“When I was doing it for a solid six months at Townsville, it was full-on,” Dr Mooi says.

“You must exercise self-care and monitor your own emotional state, because you can get drawn into a family’s emotion. You do need to be a little bit distant from it so you can practise the medicine.”

HIGHER PROFILE

Dr Mooi regularly fields questions on her passion for this area, which to outsiders can often appear bleak.

“The first few patients are always going to be very hard and tearful, but you do learn from it,” she says.

“The profile of palliative care is getting bigger... Often it’s something more mature doctors take on... but I feel it’s something that all GPs should be proficient at and take part in.”

Dr Mooi’s interest in end-of-life care saw her complete a six-month clinical diploma in palliative medicine through the Royal Australasian College of Physicians.

According to Dr Will Cairns, director of palliative care at Townsville Hospital, any training in palliative care will serve registrars with an interest in the specialty well.

“Many people [at the end of their lives] like to be managed by their GP... and many GPs see it as a rewarding part of their practice,” he says.

“As the population ages there will be more people dying and a large number of them won’t need specialist care. The fact someone is dying doesn’t mean that they have to go to hospital.”

COMMUNICATION IS KEY

Dr Cairns says registrars entering palliative care need good communication skills, and, importantly, need to feel comfortable and accept their own mortality.

“Doctors need to understand that we can’t make people live forever,” he says.

“And if we can’t fix them, we have to care for them.

“Palliative care is an important part of medicine, and even if registrars don’t enjoy it, hopefully they will come away with an understanding [because] all doctors will have to deal with a patient with life-threatening and life-ending illnesses,” he says.

Dr Cairns says training places in palliative care are becoming increasingly competitive and he hopes as the number of graduates increase, so will the number of places offered.

“New trainees in all fields are coming through, so there’s a growing awareness,” he says.

“There are lots of dimensions to palliative care... It’s not just about symptom control.”

RESOURCE BACK-UP

The role of GPs in palliative care is increasingly supported via a range of resources, including the Flinders University-backed website www.caresearch.com.au, which includes everything from advice on bereavement to the practicalities of Medicare item numbers for palliative care.

But there’s still more to be done, according to Dr Christine Sanderson, staff specialist in palliative medicine with Calvary Health Care in Sydney, who wants more research in best practice.

“There’s a huge amount of evidence that we need in order to provide good care,” she says.

“There hasn’t been a lot of palliative care research in the past, so we’re coming from behind.

“The need for research is enormous, as everyone will die and everyone wants good care at that time.”

This article was updated from the original which appeared online 07/08/2009