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As a junior doctor I have got used to seeing "regulars" in the local
hospitals. This becomes more common place during the winter months when
the COPD and Heart Failure patients have regular slots, particularly on
nights and at weekends. Although it is comforting for them to see a
familiar face and helpful as I know their histories each admission makes
me a little more downhearted, and each discharge merely starts the clock
until next time, often the following week.
As doctors, we often see the medicines we can give as the be all and
end all, and Frusemide does help and certainly makes us feel better as it
takes effect and the patient calms down. Nebulisers and steroids do
likewise and in A+E at 3 in the morning that is what you do. To discuss
the concept of Heart failure is not appropriate there and then as time and
demands are stretched. It is also one of the things doctors do and all
juniors thrive on - making immediate differences. However, the team
admitting that patient should ensure that conversation is had the next
morning. However, ensuring patients receive support and palliative support
demands money and in the current climate that is difficult.
Palliative care is all too often seen as a an area of medicine that
is only for "dying people" and takes too long for us to bother. That is
wrong. It can be just as rewarding, if not more so to patient and doctor
than giving that stat dose of diuretic.
In recent months I have referred several patients for such programmes
only to see them back in again before they reach the head of the queue. As
students we are also well drilled in "breaking bad news - Cancer related"
but maybe we should be taught more about "breaking uncertain news" because
that is what Heart Failure and COPD present - uncertainty that needs time,
effort and resources to ensure that journey, however long or short is not
dotted with frequent nights in A+E having another shot of their favourite
diuretic.
Barclay and Maher describe conversations about end of life care as
difficult. This description suggests that talking with patients about
death and dying is uniquely difficult and thus seems likely to encourage
physicians to continue to avoid efforts to acquire expertise in this
area.
Almost any complex skill is difficult to the novice. I think, as I
suspect many other physicians do as well, that such conversations are
better described as challenging, rewarding and stimulating. Such words
seem more likely to encourage physicians to develop expertise in this
area.
Better Eduction and Resources
As a junior doctor I have got used to seeing "regulars" in the local
hospitals. This becomes more common place during the winter months when
the COPD and Heart Failure patients have regular slots, particularly on
nights and at weekends. Although it is comforting for them to see a
familiar face and helpful as I know their histories each admission makes
me a little more downhearted, and each discharge merely starts the clock
until next time, often the following week.
As doctors, we often see the medicines we can give as the be all and
end all, and Frusemide does help and certainly makes us feel better as it
takes effect and the patient calms down. Nebulisers and steroids do
likewise and in A+E at 3 in the morning that is what you do. To discuss
the concept of Heart failure is not appropriate there and then as time and
demands are stretched. It is also one of the things doctors do and all
juniors thrive on - making immediate differences. However, the team
admitting that patient should ensure that conversation is had the next
morning. However, ensuring patients receive support and palliative support
demands money and in the current climate that is difficult.
Palliative care is all too often seen as a an area of medicine that
is only for "dying people" and takes too long for us to bother. That is
wrong. It can be just as rewarding, if not more so to patient and doctor
than giving that stat dose of diuretic.
In recent months I have referred several patients for such programmes
only to see them back in again before they reach the head of the queue. As
students we are also well drilled in "breaking bad news - Cancer related"
but maybe we should be taught more about "breaking uncertain news" because
that is what Heart Failure and COPD present - uncertainty that needs time,
effort and resources to ensure that journey, however long or short is not
dotted with frequent nights in A+E having another shot of their favourite
diuretic.
Competing interests: No competing interests