A Bit of Background
I’ve worked as a Specialty Doctor in Palliative Medicine since 2011, having previously been a Specialist Registrar in Healthcare for the Elderly. My decision to quit my training post and apply for work in the hospice setting was driven by a number of factors. I was burnt out at the time, I found moving around to different hospitals in a large deanery very disruptive to life and the stretched resources in hospital felt like I was doing the bare minimum for my patients in order for them to be discharged. I took some time out of medicine after 2 years as a registrar which allowed me to consider what would make my working life as a doctor a more fulfilling, less stressful and ultimately a happier one than what I had had before.
What does a typical day look like for a Specialty Doctor working in the hospice?
My working day as a Specialty doctor in the hospice usually involves a morning handover with the nursing staff and discussing hospice referrals, followed by a ward round of the patients on the unit, sometimes as part of a consultant ward round. The afternoon can involve admitting new patients to the hospice, ward work, multi-disciplinary team meetings, speaking with relatives or having your supporting professional activity session. Most Specialty Doctors are also part of an on-call rota and depending on the hospice, it may be on-call for telephone advice or admitting patients to the hospice overnight if required.
What gives me joy in my work?
I’ve always enjoyed spending time and getting to know my patients. Even in my busy House Officer year (equivalent to F1 in today’s grading), if I was having a bad day I knew that talking and spending time with my patients, getting to know them as a whole, as a person, and not just focusing on the pathology they had, would brighten up my day. Working in palliative care offers this, in fact it demands it, as treating patients holistically and as individuals involves getting to know them, and getting to know them well! Hospices usually have more resources compared to busy hospitals, to enable more time with patients and their relatives.
Treating each patient as a unique individual, one also gets to appreciate the complexities of the symptoms that patients present with, as many different factors can play a part in their symptom presentation. So sometimes that analgesic medication you might prescribe to address someone’s pain is not going to be as effective as treating their depression or their spiritual distress for example. Figuring out these different factors, how much they contribute to a patient’s symptom burden and trying different approaches to address their symptoms can be both challenging and extremely rewarding. Most patients that come under our care have come from other specialties that have nothing more to offer their patients, in palliative care there is always something more we feel that we can offer.
“Isn’t it depressing working in a hospice?” is a question I’ve been asked quite a few times, and the answer is not at all. Sure there are a lot of sad situations to deal with but one also gets exposed to the best of what humanity has to offer. The hospices I’ve worked in have been full of a lot of love, joy and laughter (you might be surprised to hear), from the patients, their friends and family, and the staff. Working together, in partnership with your patients and the other hospice team members towards a common goal of providing comfort at a very vulnerable time of someone’s life feels very worthwhile and meaningful to me.
What are some of the qualities you need to work as a Specialty Doctor in Palliative Medicine?
Having effective communication skills is essential in palliative care. You are discussing with patients and their relatives, difficult topics of conversation which can be very emotionally charged. An essential component of good communication skills, is the ability to patiently and actively listen. We are trying to elicit a patient’s concerns and fears, and enable open and honest conversations to occur.
Working closely and in partnership with the other members of the hospice team is vital. Valuing and respecting the views and opinions of the other healthcare professionals is really important in understanding patients, their symptoms and the effectiveness of management strategies.
Being able to thoroughly and holistically assess patients with detailed history taking and examination is important in palliative medicine. It’s common to spend at least an hour with patients when admitting them into the hospice.
Having your own tools and strategies to cope with the emotional load associated with hospice work is vital in remaining in palliative care long term.
What are the difficulties and challenges in working as a Specialty Doctor in the Hospice?
Working in the hospice environment is not for everyone. There are a lot of sad circumstances to contend with and regularly being exposed to death can be too overwhelming for some. Burnout in the specialty can be common. Caring can come at a cost, more so in palliative care.
The decisions made in the management of patients in the hospice are rarely black and white. Different approaches to similar problems may be needed. A “one size fits all” approach does not work in the hospice, individuals are too unique and symptoms can be too complex to adopt this method.
Sharing the care of patients with other specialties can on occasions lead to differences of opinion in the management of patients. You may also need the input of other specialties whom may deem interventions as futile. Other services that may benefit patients can be quite variable across different regions of the country.
Any other comments?
I feel extremely lucky and privileged to work in the hospice. I work with patients that are extremely grateful for the care that is provided to them and I work with a great team of caring individuals. The work that I do provides a lot of meaning in my life and I learn a lot from my patients and their experiences.