Another insightful article from Dr Ranjana Sriastava, a Melbourne medical oncologist and writer, encapsulates my recent experience as a palliative care doctor on the frontline between hope and dying in a cancer centre.
The anticipated miracles of cancers dissolving before our eyes are common enough for patients and doctors to push on with expensive, sometimes self-funded treatment (at great cost) in preference to the needed preparation by patient and family for dying. For a patient and family perspective, skip down to the comments after the article and read HugiHugo’s description of his wife’s last months while undergoing treatment.
A patient with widely disseminated and aggressive melanoma having immunotherapy grunted at me in frustration last month. “Listen,” he said, “they are all high-fiving over there in the oncology clinic. Why do you want to talk about end of life stuff? It’s really confusing.” Pretty appalled at the idea that we were giving the patient mixed messages, I was fortunate to be able to do a joint consultation with the patient’s medical oncologist to nut out our different perceptions. Unfortunately for the patient, his oncologist confirmed that the treatment was very unlikely to be a miracle and most patients in his situation would live less than a year. To say that the patient was shocked was an understatement. Had he not been referred to my team for symptom management, this conversation would have happened later – or never.
Evidence is emerging that outcomes of immunotherapy in patients with poor performance status are very unimpressive. Patients with poor performance status had been excluded from initial trials.
Where does the deficit in our communication of hope lie? Is it in the delivery by the doctor? The reception by the patient? A bit of both? How can we accurately respond to the portrayal of immunotherapy in the media and social media as a miracle cure, and allow for the possibility of benefit without downplaying the risks?
The 2017 Annual Education Update Programme is packed with many topics of interest, and will be a good opportunity to catch up with what is going on all over the country, as well as catching up with new and old friends. This year Dr Wendy Pattemore will be introducing a new session called, “Wild Successes and Fabulous Failures,” which will provide an opportunity to share how Palliative Care is done in your own ‘patch’.
Like @Elissa_Campbell, five weeks ago, rather than starting a new clinical rotation at the beginning of the medical year, I too embarked on a research fellowship. For the next twelve months, instead of trying to fit in training requirements and research projects around clinical duties, I have the luxury of being able to devote pretty much all of my time to thinking and learning about research, reading studies properly instead of quickly scanning through papers, and talking to other researchers and clinicians – who are almost always encouraging, interested and incredibly generous with their time and advice.
This is the first in a regular series of posts by Palliverse team members about their day-to-day experiences in research roles.
This week was a week of firsts for me. For the first time as a doctor, I am in a role that is primarily non-clinical. On Monday, I commenced a 1-year research fellowship based in theDepartment of Palliative Care at Fiona Stanley Hospital in Perth, Western Australia. It is also the first time I will be in the same position for a whole year (training terms for junior doctors generally ranging from 10 weeks to 6 months duration in WA). It’s the first job I’ve had where it’s my responsibility to set my own schedule, without the routine of ward rounds, clinics, home visits and consult referrals. It’s my first time working at this hospital – in fact, Monday was the first day at this hospital for most of our team. It is a brand new facility. The Emergency Department saw its first ever patient on Tuesday. More patients will be transferred from another hospital over the weekend. Our palliative care team (doctors, nurses and social worker) have come together from various services, care settings and states. It’s a great opportunity for us to learn from each other and so far it’s functioning very well. There is a fantastic energy at this new hospital – all the staff I’ve encountered are enthusiastic about change (for the better) and it is a great opportunity to get things done without the burden of “that’s how we’ve always done it” thinking. Continue reading →