Many years later it will still stand clearly in your memory, your wedding day, the day that started a new life together for you two. The ceremony in which you fully committed to each other and became; Mr and Mrs _____, or Mr and Mr ______, or Mrs and Mrs______. For better or for worse, until death do us part. What’s so different about a Hospice Wedding? Continue reading
Category Archives: Clinical
Life’s uncertainty and overdosing on medicine
This morning an article was published in the conversation by Ray Moynihan and Dr Iona Heath exploring how our society deals with the uncertainty of our future health. Faced with the knowledge that all of us will get sick and die at some stage the authors suggest that this impels us all to try and find the solution to these problems, resulting in the medicalisation of our lives, over-diagnosis and over-treatment.
Palliative medicine training in Australia
Following up from Michael’s post a few days ago about palliative medicine training jobs, here are a few more useful links for Palliverse readers thinking about enhancing their medical careers through further training in palliative medicine:
- An overview of advanced training (three years), which is required to become a palliative medicine specialist in Australia and New Zealand
- Information about the clinical diploma (six months), which offers all medical practitioners an immersive experience in palliative medicine
- List of accredited palliative medicine training sites in Australia and New Zealand
- Registrar and clinical research fellow positions in Sydney (applications close August 13th)
- Registrar positions in Canberra (applications close July 31st)
- Registrar and fellow positions in Victoria (applications close August 10th)
- Information about palliative medicine training in Queensland
- Apply for palliative medicine training in South Australia (applications close July 31st)
I couldn’t find much stuff online about palliative medicine training in New Zealand, Western Australia or Tasmania. If you know of any good resources on these topics, please share them with the rest of the Palliverse community! Thanks in advance 🙂
Palace of Care – Tell me what the best thing you did this week was…
The other day I made a patient laugh and smile, two of my favourite things to do as a doctor.
Two men from completely different walks of life, in the space of 15 minutes, made a human connection through humour, blokey-ness and general conversation.
I wished him a good night and said that we would talk again tomorrow about transferring him back to his original hometown.
Neither of us knew that mere hours later one of us would not be alive any more.
Please share with the Palliverse community what the best thing you did all week was.
Cheers,
James
Shifting the focus of care from disease to people – heartfelt article about dying in acute hospitals
This article is going a bit viral on social media. Does it mirror your experiences? It certain does mine, having worked for a long time in consultation services in acute hospitals. There have been a number of comments and letters to the Age supporting the message of the article, written by a senior doctor about the death of his father. http://www.theage.com.au/comment/hospitals-must-shift-focus-of-endoflife-care-from-disease-to-people-20150707-gi6joz
MyPal Podcasts
Do you like technology? Innovation? Palliative care? Research? Why, these things are what @palliverse is all about – and why you/we are here in the first place!
Guess what? These things are exactly what the #MyPal podcasts from @amaranwosu are all about as well. How about that!
Check it out here and also on iTunes. Be amazed. Happy listening!
Online Pain Module – RACP eLearning
I have just been prompted to have a look at the excellent eLearning Pain Module for the RACP. In short it is a fantastic resource that I encourage anyone with access to have a look at here. As I understand it access to this resource is limited to fellows and trainees of the Royal Australasian College of Physicians and its administrators so my apologies to anyone not fitting that description reading this blog, as the following may come across as a bit of a tease. (Ed Correction: We have just been informed that anyone can apply for access through the site linked above – i.e. Read on, it is not a tease at all)

RACP eLearning website https://elearning.racp.edu.au/
I think therefore I am? – Alcohol hand-rub and the clinical application of Mindfulness
Mindfulness in recent years has become increasingly fashionable throughout the world and is popping up as part of treatments in Psychiatry, as part of the rehabilitation of prisoners, and even in the Palliative Care world. Is it really all that new or is it the repackaging and re-marketing of what Buddhists have been doing for thousands of years? What follows is my own personal experience of Mindfulness and how I apply it to my practice of Palliative Care.
I had been interested in meditation since the late 1980’s when I read in a Batman comic that when he was completely exhausted, instead of sleeping, Batman would meditate briefly. This would leave him refreshed and able to go out and fight the bad guys again in a few hours’ time. Having never been a fan of sleep in general, the idea of a sleep substitute really appealed to my younger self. Throughout the 1990’s I explored various types of meditation practice, but had largely given up by the 2000’s.
In September 2013 I had signed up, in my usual last-minute fashion, to a pre-conference workshop at the APHC 2013 conference held in Bangkok, Thailand. Having registered for the workshop very late I was left with only one option. The workshop entitled, “Mindfulness in Clinical Practice,” turned out to be the highlight of a very enjoyable conference.
Less than a week later I was in Montreal, Canada for the 1st Whole Person Care Congress in which a number of the sessions and workshops were devoted to Mindfulness. It really had become the flavour of the month on a global scale, but did it spur me into a programme of regular Mindfulness practice? Heck, no!
It wasn’t until October of last year that I decided to give Mindfulness meditation a proper go, via the Headspace app. This easy to use program of guided meditations has led to me doing 236 sessions and has had various benefits. A greater sense of calm, better observation skills, greater ease at falling asleep, and even benefits for my patients.
What is the connection to alcohol hand rub?
As a Medical Registrar the importance of clean hands was drilled into me by an Obsessive/Compulsive trait possessing Physician who went through 500ml of Alcohol hand rub per day in his quest to limit the spread of hand-borne contagion. Apologies for the next sentence…some of it rubbed off on me. As part of my own personal ritual, prior to knocking on the door of patients, I will douse my hands with a good squirt of the alcoholic jello-shot. While I am rubbing my hands together I take a deep breath in, and slowly release it. This brief amount of time allows me to centre myself so that I can be truly present in the clinical moment that follows.
Being in the moment with the patient allows me to “tune in” to what they are going through, and to gift them my full attention. I’m not thinking about what is for dinner, what my plans for the weekend are, what an interesting shadow is being cast on the wall, but instead I am able to focus on what they are saying, verbally and non-verbally. Of course this doesn’t happen with every single patient encounter that I have, but when I am “in the zone,” the patient’s situation becomes much clearer to me. I end up with a much better idea of what they want and need. This fleeting moment full of human mind connection still surprises me at times. It feels like it is a little piece of magic, something to be approached with wonder.
The patients seem to enjoy it too.
At the end of the visit I say my goodbyes and reverse the entry ritual. Another squelch of disinfecting viscous chemical is applied to my hands, another deep breath is taken and released. The ward round continues.
free smartphone app for GPs providing palliative care
There’s an app for that! ABC news writes that a new smartphone app can help guide GPs in management of patients approaching the end of life.
It’s free from iTunes and provided to you by the lovely chaps at Flinders University in SA.
We would love to hear from GPs or trainees – what do you think?
Sonia
ASCO 15 – Early palliative care in an inpatient oncology setting improved outcomes and satisfaction
Sadly, I am not actually AT ASCO, the annual meeting of the American Society for Clinical Oncology which is taking place in Chicago this year.
However thanks to the modern day marvels of social media I was able to watch this lecture by Dr Riedel and a team at Duke University Medical Centre.
Dr Riedel introduced a model where palliative physicians ( “palliatricians”. What do you think? I love a neologism, myself….) co-rounded with the oncologists in the inpatient oncology unit.
Statistically significant reductions in length of stay (LOS), 7 and 30 day readmissions, and ICU admissions were demonstrated. Nurse and doctor satisfaction was increased. Nurses felt the quality of care was improved.
All the medical oncologists surveyed felt that the palliatricians added to the care of the patient and that they learned some stuff about symptom management. I know I learn heaps when I round with medical oncologists! Communication and collaboration was improved.
It was a shame they didn’t look at patient satisfaction, but hopefully that might happen in future.
Seen anything interesting coming out of ASCO this year?
Sonia



