Friday, 19 April 2013

"Dying ain't easy"

It really is a privilege being GP. Ok there is the increasing hassle from the Department of Health (it feels like there has been constant meddling and change for at least the last 10 years), but every now and again, the patients bring you back t the essence of it all.

So today I visit a dear chap who is dying with cancer.  His opening words to me as I crouched by his bedside, "dying ain't easy", set the tone for our entire conversation and enabled the whole encounter to be marked by openness and honesty-and I hope not a little empathy.

Care of the dying is immensely important in general practice and has been a feature of it for centuries. Ok end of life care has greatly benefitted by the hospice movement over the last 40 years or so, and by the more recent formalising of it with end of life teams springing up everywhere. But none of this takes away from a GP's role. So what do we bring that others don't?

1. If we have been in a practice for a decent length of time we will hopefully have established a relationship with the patient when formerly they'd had only minor illness.
2. As a result of a prior knowledge there will be shared memories and experiences which can be  reminisced over
3. It also might help in anticipating what sort of management and care the patient would most wish for.
4. GPs generally see the bigger picture. This including knowledge of other members of the family and their relationship with the patient, and indeed any specific care and support that they may need through the dyng process.
5. A knowledge of what medication can now be stopped  (since the benefits may be designed for the long term, such as BP treatments), and not just what therapy the patient may now need.
6. A familiar regular face, especially if the dying process is prolonged. It is not just what you do that matters to the patient, but who you are. It's much harder for the patient if different doctors and nurses and others see the patient. This is one of the potential downsides of part-time working and is certainly a consequence of the loss of  old style on-call arrangements when a certain amount of night cover was provided by the patient's own GP.

No, it ain't easy dying.
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