Dr Naomi Bowers is a GP with a special interest in palliative care, and has worked in the space for many years. Here she explains why it needn’t be an area of medicine to fear but rather embrace, particularly as you can make an enormous lasting difference to patients and their families.
Palliative care experience
Naomi’s first taste of palliative care was at medical school back in the UK.
“I chose it as an elective in my final year and did it for two months full time. It was the first time I thought ‘this is the type of medicine I really want to practise’, mainly because it was so wonderfully patient-focused,” she explains.
After travelling to Australia for a better work-life balance, Naomi did a Diploma in Palliative Medicine before moving onto GP training. During this time, another opportunity popped up that was too good to refuse.
“The consultant from the unit where I did my diploma left and they didn’t have anyone to fill the position. So I, alongside another GP and a palliative care physician who was close to retiring, divvied the job up between us, and that’s when I started working as a palliative care Senior Medical Officer (SMO),” she says.
Naomi practised in the SMO role for a number of years, whilst also working at the local community outreach service, visiting patients in their own home.
“My main love is community work as it is such a massive privilege to be invited into someone’s home when a loved one is dying,” she says.
An area to love, not fear
Naomi feels there’s a misconception about working in palliative care, and that it couldn’t be further from the truth.
“People think palliative care is terrifying, but it’s probably my most joyful place to be. I would often come home happy knowing I’d done great work that day and made a lasting difference that would help that family for years to come. That’s because when someone dies a terrible death, it’s a horrible outcome not just for that patient, but for their entire family. When someone has a good death, that leaves a much different legacy for their family,” she explains.
While there are many professional benefits, working in the area has also had a big impact on Naomi personally.
“It shaped me and it still shapes me today. I’m just so aware that our lives can change in an instant and that I need to enjoy my life and my kids. So yes, we should go on that holiday because who knows if we’ll all be here next year. It’s helped me focus on living the best life I can,” she smiles.
According to Naomi, while the positives outweigh the negatives, there’s one challenge that stops many GPs from working in the area.
“These patients often require long consults and at some point, will need home visits. GP home visits are not remunerated very well, and that’s a huge flaw on behalf of the government. It creates a massive problem for palliative care units as they can’t find GPs who will do home visits,” she explains.
“But if you can make the time for it, it is incredibly rewarding and a real privilege. And those families will be extremely grateful for the care you provide at a very important time in their loved one’s life.”
Palliative care tips for registrars
Naomi offers five key tips for supporting for your palliative care patients.
- Rethink your definition
“In general practice, it’s important to broaden your scope of what you see as a palliative care patient. While one of the most common palliative care presentations are cancer patients, don’t forget about your heart failure, COPD and elderly patients too.”
“Ask yourself the question – would you be surprised if this person passes away within the next 12 months? If the answer is no, then carefully consider their quality of life. For instance, if they’re 93, do they really need to have a three monthly cholesterol check? Can you safely reduce the burden for them?”
- Communication is key
“In palliative care, your communication skills are vital. It’s essential to find out what your patients actually want to know because some don’t want to know anything, others want to know everything, while others again don’t want to know but are happy for their family to.”
“That’s why it’s key to have these open discussions, whilst also making sure they’ve got a way of linking in urgently if something goes wrong – whether that’s through the palliative care nurses, phoning your reception, or contacting an out of hours GP service.”
“If a patient tells you they want to pass at home, discuss it realistically. If they live on their own and don’t have (or can’t afford) 24 hour nursing support, it’s unlikely they’ll die at home. I had one patient in this position and after some careful questioning uncovered he just wanted his dog with him at the end. So we organised that with the palliative care unit. At the end of the day, don’t feed unrealistic expectations because it’s much harder for your patient if you have to renege on what you’ve told them is possible.”
- Rely on the right resources
“Healthpathways have some amazing resources on the management of palliative care symptoms and end-of-life care. Never be scared of contacting the local palliative care unit, as those physicians are some of the nicest people you’ll ever find, and everyone will be very eager to help you. The community palliative care nurses are also an excellent resource if you’re struggling, because most of them have been on the job for a long time and likely know as much as most palliative care registrars.”
- Do an advanced care plan
“In Queensland, we’re lucky we have some advanced care planning forms that are very easy and quick to fill in that can then be put on a central register. That gets uploaded onto Queensland Health electronic records, so if your patient ends up in emergency, those doctors will be flagged. They can then read the plan and ensure their treatment aligns with what the patient has discussed with you and what’s been signed off.”
- Don’t forget about the family
“An integral part of making sure that someone has a good death is supporting the family too, both during and afterwards.”
Getting further experience in palliative care
Naomi says one good way to get further palliative care training is to do the same diploma she did, which is a full time six month course. However, there is another option that might suit your training needs better.
“The PEPA program is amazing. It’s an initiative to encourage more GPs to get training within the space. You can do a two to five day placement where you go and work within the palliative care field to gain experience. If you’re rurally based, they may even cover your travel costs,” she says.