Tuesday, August 30, 2011

"I don't need your help - I know what I am doing"

Well, so much for posting weekly - sorry. I am still to get back and unpack the headline comments in my earlier post about the core elements of the Dying Friendly Hospital. However I am prompted today to give voice to an example of the problem faced by many specialist consultative services in seeking to create better end of life care.
As captured in the title of this posting, a particular barrier to achieving better end of life care in our hospitals is the belief by some health care practitioners that they know how to do "it" - be it pain control or symptom management or end of life care. Indeed, let me say clearly that there are many clinicians who do know how to deliver a good standard of these. Regretfully there are also those whose belief in their own practice does not match up with best known practice. This group either do not seek the advice or support of specialist palliative care services, or ignore the advice / management suggestions offered when they do ask. What can be more distressing is when different clinicians on the ward become discomforted by what they see as less than optimal care, and try to use the palliative care team to "fix the problem".
It is possible that palliative medicine is the only modern medical speciality that so many practitioners who are not trained in it can believe they know all they need to know to practice it. It is also possibly the only speciality that finds itself being told by others what our practice and service provision should be. The former is a significant barrier to achieving quality end of life care in our hospitals. The latter is symptomatic of the lack of understanding about the central responsibility of our hospitals to provide such care.
We need our hospitals to be safe places for our citizens, who have no other options, to die safely.

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