Having followed the Telegraph and Times articles recently, I found
Zosia
Kmeitowicz's report on the audit of nearly 4,000 deaths a refreshing
change.
Like Dr Peter Hargreaves (Telegraph letters 06 Sep 09) I too find that 50%
of
hospice patients return home, but regardless of whether they have ever had
intravenous or subcutaneous rehydration. Like Dr Hargreaves I would be
extremely concerned if the management of the side effects of drugs was
managed by sedation, if the situation is reversible. The Liverpool Care
Pathway does not remove the clinician's responsibility for practising good
medicine, in fact if used correctly, the LCP demands very regular clinical
review and decision making by the whole team.
Tools are neither good nor bad in themselves but used well or badly by the
craftsmen who use them. If Dr Hargreaves finds the problems he alludes to,
I
suggest he needs to look at how clinicians in his area are being educated
in
their assessment and care of the dying, since the results of the National
Care
of the Dying in Hospitals Audit do not confirm his claims of deaths from
'continuous deep sedation'. Correct use of this 'tool', the LCP, makes no
difference to the timing of death but makes a significant difference to
the
quality of the life that comes before it and the experience of dying and
death
for patients, families and clinicians.
Before we terrify the public yet again with news that the medical
profession is
not to be trusted with their care, let's not throw the baby out with the
bathwater.
Rapid Response:
Clinicians should practise good medicine
Having followed the Telegraph and Times articles recently, I found Zosia Kmeitowicz's report on the audit of nearly 4,000 deaths a refreshing change. Like Dr Peter Hargreaves (Telegraph letters 06 Sep 09) I too find that 50% of hospice patients return home, but regardless of whether they have ever had intravenous or subcutaneous rehydration. Like Dr Hargreaves I would be extremely concerned if the management of the side effects of drugs was managed by sedation, if the situation is reversible. The Liverpool Care Pathway does not remove the clinician's responsibility for practising good medicine, in fact if used correctly, the LCP demands very regular clinical review and decision making by the whole team. Tools are neither good nor bad in themselves but used well or badly by the craftsmen who use them. If Dr Hargreaves finds the problems he alludes to, I suggest he needs to look at how clinicians in his area are being educated in their assessment and care of the dying, since the results of the National Care of the Dying in Hospitals Audit do not confirm his claims of deaths from 'continuous deep sedation'. Correct use of this 'tool', the LCP, makes no difference to the timing of death but makes a significant difference to the quality of the life that comes before it and the experience of dying and death for patients, families and clinicians. Before we terrify the public yet again with news that the medical profession is not to be trusted with their care, let's not throw the baby out with the bathwater.
Competing interests: None declared
Competing interests: