Pallative Care in GP and the Fear of Dying

general practice Jul 05, 2018

Hello, my name is Tom Rolley.

I  wanted to discuss palliative care and had a patient come in this morning and he was disappointed in that how care that her, one of her parents received.

And for me it's an interesting one cos it can bring up a lot of my own fears, in dealing with palliative care and if I'm not aware of that stuff, then I can end up not providing good management in pal care. So what I think about palliative care?

As a doctor, it forces me to confront my own fear of death.

That's what I see when I hear about palliative care not being done well, I'm like okay, I just wonder whether that doctor's not okay with the fact that they're going to die.

And therefore when they're treating the patient in palliative care, therefore it is hard to actually be okay with making decisions.

So some of the things that come up are, "Should we transfer this patient to a different hospital to get this thing looked at?"

No. They're dying, they are dying.

They're close to death.

Transferring to hospital is not a good outcome for that patient.

Or, "Oh what about if we give some morphine and is that going to kill them?"

And I'll be held responsible.

It's like, no, but if they're in pain they're going to need some morphine to make it a good death.

And as I said, underneath all of that I need to be okay with the fact that I am going to die.

Otherwise my fears about death can come through and influence the types of management that I implement.

So it is worthwhile looking at, hey I am going to die and therefore what else have we got?

Well perhaps there's other things around ... other models besides straight western science. Which really struggles with working out, hey is there anything to continue on?

But there are other models within the world, around teachings that perhaps there is a body and there is a spirit.

And I am certainly okay with that, seems like at minimum when I'm dreaming at night, I'm not in my body.

I'm somewhere else.

So I have a conscious awareness of that and I'm going to put that down as a spirit within and therefore when the body dies, the spirit continues and I don't have to be so freaked out about actually somebody dying.

So I think that these concepts are very hard in western medicine.

How can we run a randomized control trial over palliative care or does the spirit exit the body?

But nonetheless it's going to require some kind of insights into that and for me, the tools are, yes there are texts around that. I can read books that are spiritual in nature.

Or I can try and have direct experiences through meditation.

It's usually the best experience that I have had.

Why, I've certainly practiced a bunch of Qigong methods and it seems like the reality that you gets created from those types of forms, is a separate reality.

A separate experience within myself of doing those forms.

So meditation, confronting death, all helpful in dealing with better palliative care.

Hope you've enjoyed this, hope you find it useful, and yup, look forward to seeing you on future live videos.

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