I think therefore I am? – Is healing possible at the end of life?


Photo by Glen Carrie

Since arrival she had been very anxious and spent most of the first few days alone in her room. “I don’t want to interact with anyone, please leave me alone, keep the curtains closed and the lights off” – like a hermit crab withdrawing deeper into her shell.

Worsening pain had brought her to us, severe physical pain, the result of increasingly bad news about the toll her disease was taking on her body over the past six months, and also likely emotional pain as evidenced by worsening anxiety. Despite the team’s best attempts at connecting she remained aloof and guarded, sleep being a source of solace.

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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

RACP eLearning website https://elearning.racp.edu.au/

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Vital talk – resources for improving your communication skills

Have picked up some great tips from these guys when I have seen them at palliative conferences.

Communication skills are something that you can always improve, even if you have been in the field for a long time!

The site offers videos with examples of communication skills and also cheat sheets of suggestions on how to structure difficult conversations.

Do you find them useful?


Special guest post – Dr Chris Sanderson on #lettertome

Dear readers,

We are honoured to bring you a guest post, in fact two, and indeed we hope more, from the fabulous Dr Chris Sanderson, palliative care physician.  I have to say that I was so inspired by this idea, by putting patients at the centre of our communication, where they should be, that I totally stole this idea for my own Change Day pledge.

Below is part one of her description of her pledge for Change Day, #lettertome.

#lettertome : A twitter campaign to improve how we share information with patients.

Social media is such a wonderful space for spreading ideas – and sometimes the simplest ideas may convey a world of significance. Recently on twitter, there was a conversation between various doctors and patient advocates about how we speak to and about our patients, and the subject of doctors’ letters was raised. Thus was born a new hashtag, a pledge for Change Day Australia, and potentially a new way of doing things.

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Diabetes management at the end of life

Diabetes management in palliative care is often tricky. Trying to optimise quality of life, and finding a balance between the burden of diabetes treatment (such as checking blood sugars, diabetic diet and medication side effects) and the sequelae of uncontrolled blood sugars (like unpleasant symptoms and infections) is difficult. As a patient’s weight, diet, metabolism and organ function change, the risk of hypoglycaemia (low blood sugar) increases. Adding further difficulty is that patients with chronic diabetes have often spent years being told that they need to keep strict control of their blood sugars, in order to avoid the awful long-term consequences of poorly-controlled diabetes. It can be difficult to convince patients, their families and carers blood sugar control can be relaxed in the palliative care setting. Continue reading

“Sonia’s sign” – conjunctivitis as a novel indicator of the terminal phase?

Generations of junior medical staff had internally rolled their eyes when I voiced my theory about conjunctivitis meaning that the patient would die soon, then been astounded by my prognostic skills when the patient deteriorated into the terminal phase. It was time to put my reputation where my mouth was and do a prospective audit. Did diagnosis and treatment of conjunctivitis in the inpatient palliative care setting mean that the patient had a very poor prognosis? Continue reading