Dr Eleni Tsiompanou and Dr Ollie Minton discuss opportunities and developments in palliative medicine and talk about the philosophical side to it.
Palliative physicians provide medical input and leadership to hospices, hospitals and community settings for patients with life limiting illnesses. They work usually as part of a multidisciplinary team (nurses, councillors, physiotherapists etc), and within a hospice palliative physicians will be the consultant in charge of someone’s care but outside of this our input is primarily offering advice to others – specialists and GPs.
They see all conditions both cancer and non-cancer based on need but usually when someone has been identified as being within the last year of life (on average). Alongside the direct clinical contact often there is an extensive ongoing educational role to promote end-of-life care. As you might expect, many non-palliative care specialists often don’t feel confident in this area.
I chose it following a period of general medical training and oncology. I found myself attracted to the speciality following a hospice job which I did immediately afterwards. I found the time I was able to devote to patients and the broader involvement of other members of the team really strengthened my work. As I have continued to work with a variety of specialists (mainly oncology but also others) I have kept a broad focus and clinically see a wide variety of patients with a range of conditions.
Alongside the clinical work like most specialties there are opportunities for education and research. This can be in a variety of areas from basic science through to ethics and spiritual aspects for example through many other areas. This breadth of interest is a credit to our speciality both in education and research.
We see almost entirely patients who are within the last year/months/days and hours of life. Our image as a speciality can be affected by this and often we are not referred patients until very late on in their illness. This can provide a unique set of challenges although as a speciality we have embraced those to ensure we provide and promote end of life care. We also promote the area of planning and discussing a person’s wishes when diagnosed with a life limiting or terminal diagnosis. There are a number of national organisations such as Dying Matters and Hospice UK that are also closely allied to our specialty and the relationship to charities is also unique. Not all of us work within the NHS and hospices still only receive a small percentage of their costs from the NHS – so working within these areas can potentially provide a unique challenge. However because of this I find my work very rewarding being involved at an obviously very difficult time but having the ability to make an impact.
Dr Ollie Minton PhD FRCP FHEA, consultant in palliative medicine and honorary senior lecturer, St George's Healthcare NHS Trust, London
Dame Cicely Saunders opened St Christopher’s Hospice in south London as the first academic hospice in 1967. It was a place where patients could go for relief of ‘total pain’ with its physical, psychological, social and spiritual dimensions. Through the education and research mission of St Christopher’s, Dame Cicely is credited with founding the modern hospice movement. She held more than 25 honorary degrees and her awards included the British Medical Association Gold Medal for services to medicine, the Templeton Prize for Progress in Religion, the Onassis Prize for Services to Humanity, the Raoul Wallenberg Humanitarian Award and the Franklin D. Roosevelt Four Freedoms for Worship Medal. A bronze portrait bust of Dame Cicely stands on the upper gallery of the Dorchester Library at the RCP and from the archives we have her Munk’s Roll obituary.