[Magdalen] RIP Sir Terry Pratchett

[sally.davies at gmail.com]

Some doctors here have been to Cardiff where there is a 'state of the art'
Paliative Care course. The way they do it there, with certain conditions
(not sure what the trigger conditions are), the PC team is automatically
involved from the first admission to hospital. The patients and famiies
know them. As an illness progresses their centrality in treatment might
shift but they're always there to advise on the same issues e.g. comfort,
pain relief, nausea relief and so on.

For those interested in the nursing side, I found a very useful tool, the
Edmonton Symptom Assessment System which invites patients to rate nine
different areas which are often problematic in palliative care. Perhaps if
something like this is used, a high score or distribution of scores could
trigger a referral?

But Jim, I agree with you completely, medical cultures are highly resistant
to change even when the effects on patients and outcomes are negative...

Sally D <apologies if this is getting a bit too technical>
On Fri, 13 Mar 2015 at 19:53 James Oppenheimer-Crawford <
oppenheimerjw at gmail.com> wrote:

> I wonder if anyone would refer to the palliative care team?
>
> I recall listening to a lecture by Kuebler-Ross. She was instructing some
> nursing students, and they got the idea of looking at cases of terminal
> patients.  Everywhere they inquired, however, the answer was the same: "No
> one is dying on this ward." This despite the fact that at that facility,
> there were a significant number of deaths on a daily basis.  This sparked
> the idea of looking into death and dying. In the few cases I have been
> familiar with, hospice services were called for when the patient was within
> a day or two of death, and it was utterly pointless. Things are better in
> that regard, I'm sure.  But I'm also sure that some induhviduals will
> simply refuse to admit the patient might be terminal until they cannot find
> a pulse.  I guess it's a natural defense mechanism, but still ...
>
> James W. Oppenheimer-Crawford
> *"A life is like a garden. Perfect moments can be had, but not preserved,
> except in memory. LLAP**"  -- *Leonard Nimoy
>
> On Fri, Mar 13, 2015 at 12:38 PM, <sally.davies at gmail.com> wrote:
>
> > ...
> >
>
> 
> > The best practice is to have a Palliative Care team in every hospital,
> > working alongside the regular doctors and effecting a seamless transition
> > that involves patient and/or family, nursing staff and medical staff all
> > working together to obtain the best possible outcome. Most hospitals can
> do
> > it - no extra staff need be employed, you just have to identify the
> people
> > who really care about this and equip them to play that role. But our
> > medical culture i.e. "my patient, my responsibility", does not favour a
> > team approach even when lip service is paid to that. This is in the
> Private
> > sector; the State sector here is mostly too overwhelmed, so we have the
> > opposite problem, needless loss of patients who could be saved with the
> > correct interventions.
>