Specialty spotlight – palliative medicine

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.

Why choose palliative medicine?

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.

What is the most unique thing about your specialty?

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 Georges Healthcare NHS Trust, London

Dr Eleni Tsiompanou talks about the philosophical side to palliative medicine and the difference it makes to patients.

You can also read Dr Tsiompanou's article in Clinical Medicine Journal: Overfeeding and overhydration in elderly medical patients: lessons from the Liverpool Care Pathway.

Dr Ollie Minton discusses opportunities and developments in palliative medicine

Training and working in palliative medicine

For information on the training pathway, see the Joint Royal Colleges of Physicians Training Board. You can learn more about the recruitment and interview process through ST3 recruitment.

For information on the MRCP (UK) exam, including PACES, see their website. There is also a Specialty Certificate Examination in Palliative medicine.

Conferences:

RCP Conference - Dying in hospital: 10 November 2015, London

RCP Conference - Advanced Medicine: 9 - 12th February 2015, London

APM Neurological Special Interest Forum: 19 March 2015, Manchester

APM 3rd Biennial Conference and AGM: 23 April 2015, London

EAPC 2015 14th World Congress of the European Association for Palliative Care: 8 May 2015, Copenhagen (Denmark)

Resources

RCP publications:
Clinical Medicine articles:
CME palliative care (in Clinical Medicine):

June 2014 issue:

June 2010 issue:

Available from RCP library services:

Library ebooks and ejournals available to members via RCP Athens include:

  • The Oxford handbook of palliative care
  • Case studies in palliative and end-of-life care from Wiley-Blackwell.
  • BMJ Supportive & Palliative Care,
  • the American Journal of Hospice and Palliative Medicine,
  • Journal of Palliative Care,
  • Palliative Medicine: The Research Journal of the EAPC.

Print books for loan from the library include:

BMJ

Pharmacovigilance in hospice/palliative care: net effect of gabapentin for neuropathic pain

SPC Journal

Poignant moments in palliative care

Student BMJ

Association of Palliative Medicine resources

What does RCP do for palliative physicians?

RCP has a Joint Specialty Committee (JSC) for Palliative Medicine, the chair of which is Dr Wendy Makin. For more information on the committee and its work, please email: pauline.whitelaw@rcplondon.ac.uk

National Care of the Dying Audit of Hospitals

Palliative medicine and the RCP's history

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.

Read our blog post about Dame Cicley, ‘There is still so much more to be done’