Palliative care is not just for those who are dying
BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2846 (Published 15 June 2016) Cite this as: BMJ 2016;353:i2846
Chinese translation
该文章的中文翻译
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
This has been an inspiring story to read as a fourth year medical student. As students we are rarely exposed to such sensitive topics, and often are, understandably, asked to leave the room when bad news needs to be broken.
This is a skill which is so important, and yet difficult to get right. After watching a doctor break bad news to a patient just a few days ago, I thought for days about how frank and honest the doctor had been with the patient. I was impressed at how successful this had been, and how grateful the patient was to have everything so clear in his mind towards the end of the consultation, however bad the news was.
This article has confirmed everything I learned that day. On reading this article, it is fascinating and reassuring to hear how the doctors slow, gentle approach calmed Ana, and how his words which were precise, straightforward, no-nonsense paired perfectly with his soft approach.
This article has instilled in me an understanding of the importance to never give vague statements in order to cushion the blow of death or illness. This is a such an important learning point for medical students and medical professionals, and I hope to be able to approach sensitive issues in such an effective way as Ana has described in the future.
Competing interests: No competing interests
You know when joy lives alongside grief.I felt freezed.I tried to make sense of what was happening but I couldn't.If death is the only constant in life.A kaleidoscope of emotions overshadowed my mind.This couldn't happen to me..........I was standing by my little angel for two hours.
I rushed to the hospital.No fetal heart sound ended in tragic still born/macerated baby.He had left us...The words no parent even intends to hear in their lifetime.My baby,my long awaited precious gift was taken from me.Why me?
When I was returning back from my baby's burial ground I was heartbroken and devastated that my son would never know his twin and find what could've been a fond affection of elder brother.It was mourning twice:the loss of my angel prince and loss of my dream.I try to pretend that nothing happened; everything is alright.I couldn't stop crying.
The only hope I am not alone.I have a beautiful baby.A baby born is always a miracle.I will treasure him.This baby will have a home filled with love.I would like to convey my gratitude to the doctors,sisters,my friends who's silence presence give me strength to withstand the indelible pain.
Competing interests: No competing interests
I am pleased that Ana has felt able to write this piece. Although I write about the deaths of adults, and usually when those dying patients are in their own homes, we need to have as many people as possible writing about their experiences of death, on 'professional forums' such as theBMJ, if we are to increase understanding of 'dying and death' within both the public, and also within clinicians and other involved professions.
We also need contributions from all types of individuals: from 'empathic souls' all of the way through the spectrum to 'nerdy analytical types' [such as myself].
Competing interests: No competing interests
Comforting vague words can have bad long-term consequences
Helena M Jones (20 June this series of responses) has commented that 'This article has instilled in me an understanding of the importance to never give vague statements in order to cushion the blow of death or illness', and in my earlier response (17 June) I pointed out that I'm a 'nerdy analytical' type. If Helena reads 'Tina's story' (below), I hope it will 'make her think' in the way that Ana's article has.
There can be other long-lasting, and unforeseen, consequences of 'vague statements', or 'kindly-intentioned words', during end-of-life in particular: and these consequences, do not necessarily fall on the patient. I have recounted the long-term consequences of 'vague and kind words around dying' being used by a hospital doctor, in my addition at 30/01/15 - 14:28 to one of my online pieces (ref 1). The combination of 'kind words around the situation' and the urgency for a decision to be made, left the person I describe as 'Tina' with a nagging doubt, which only occurred long after the discussion, and there was also a breakdown in relations between Tina and a sibling. These consequences are long-term and significant - but, they might be 'less than obvious' to a hospital doctor, especially a young doctor.
Ref 1 Please note: the part I am pointing at is the third section, posted at 30/01/15 - 14:28 , and 'internally titled' with 'WHAT CAN BE KNOWN ?':
http://www.dignityincare.org.uk/Discuss_and_debate/Discussion_forum/?obj...
Competing interests: No competing interests