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Specialty career profile: palliative medicine

Dr Richard Berman FRCP MRCGP shares his experience in what influenced his choosing palliative medicine, what training involves, and what it's like to work in the specialty.

What made you decide to choose palliative medicine?

I wasn’t sure which area to specialise in for the first few years. But as a junior doctor in GP training, I attended a palliative care lecture at a local London hospice. The consultant who presented the talk was superb – I was really impressed by his enthusiasm for the specialty, so I applied for a job there.

Whilst working in the hospice I enjoyed the mix of medicine, particularly pain and symptom control, and the challenges around talking to terminally ill patients. After obtaining my MRCGP, I enrolled in specialist training in palliative medicine in Manchester, my home town. I loved it from day one.

What training do you have to do to get into palliative medicine?

You need 4 years' specialty training. I trained as a GP initially. I did my MRCGP but decided I wanted to do palliative medicine rather than general practice after my experience in the hospice.

What rotations did you do in your training? What did you find helpful?

The GP vocational training scheme provided a good basis for training in palliative medicine. It teaches you to think laterally and practice holistically, both important traits of a palliative medicine physician.

Do you work closely with other specialties?

Yes, especially oncology, surgical oncology, pain and anaesthetics (I work in a large cancer hospital). My colleagues in hospices and district general hospitals have good links with elderly medicine, general medicine and plenty of other disciplines, because palliative care crosses many specialties.

What are the best things about working in palliative medicine?

I really enjoy the clinical work. It’s satisfying when patients with terminal illnesses ‘feel better’ following your interventions. But there’s also the non-clinical stuff – teaching, research opportunities, building a new service, being invited to sit on national committees etc. – all in the context of a rapidly changing and growing specialty. The profile of palliative care is increasing year on year – it’s very exciting stuff really.

Palliative care is a rapidly changing specialty. From a clinical/technological viewpoint there are many new analgesics and medicines to help with symptom control which are being developed with increasing frequency.

In terms of the specialty, palliative and end of life care are high priorities for the NHS. There are many national guidelines and government directives developed over recent years which are helping to shape the specialty. Shaping the specialty is steady progress and important stuff. The other big issue is helping to change the public’s perception of death and dying, to allow more people to be cared for according to their wishes, in a place of their choosing.

And what are the main challenges?

The challenges include teaching, raising the profile and educating the public about palliative care.

A common misconception is that we are just about the last days or weeks of life… we’re not. Palliative care can start from diagnosis if the patient has complex problems (pain control, difficult symptoms, psychological). Palliative medicine physicians have considerable expertise in managing/supporting patients with terminal diagnoses and one of our aims is to encourage early involvement so we can help improve patient care. This increasingly includes patients with progressive non-malignant conditions.

What are your typical working hours?

It’s hard work in a busy cancer centre, but very rewarding. I work long hours, including on calls. I also have a private practice. Some of my colleagues work part-time and flexibly, but that can be a challenge. Many palliative medicine physicians will work across more than one site (eg hospice and hospital). I also get 6 weeks annual leave plus holidays. There are also opportunities for travel – I’ve been asked to advise on palliative care service development in other countries including Saudi Arabia, Eastern Europe and I know colleagues who have presented in China, Japan and Israel.

Are there opportunities for teaching or lecturing?

Teaching is a very important part of my job (as for all palliative care specialists). As we are in short supply we have to teach others and spread good practice. I am also undergraduate lead for our trust and am involved with integration of palliative medicine into the medical student curriculum.

Are there opportunities for research?

This is an expanding area for palliative care. There’s plenty of opportunity for research and we need more palliative care researchers and academics in the UK.

Do you work closely with other healthcare colleagues or groups?

Yes especially oncology, surgical oncology, pain and anaesthetics (I work in a large cancer hospital). My colleagues in hospices and district general hospitals have good links with elderly medicine, general medicine and many other disciplines, because palliative care crosses all specialties.

Working in multidisciplinary teams is important in this specialty – clinical nurse specialists in palliative care, physiotherapists, OT, dietetics, SALT, chaplaincy etc.

What is the required mix of skills for this specialty?

• excellent communication skills
• empathy
• good diagnostician
• ability to help and manage people with difficult pain and symptoms, challenging psycho-social problems, ethical challenges at the end of life
• a good teacher
• have vision to help build services and take forward the speciality.

What advice would you give to someone considering a career in palliative medicine?

Find your local friendly palliative medicine consultant. Find out if there are any opportunities locally – try and get a job in a local hospice or hospital team, go on a course or two, see if it is right for you. All you need is determination and you’ll get there.

What I like to see in a junior doctor is being a good diagnostician, a good communicator, able to work in a team, and not afraid of making decisions. You need to be happy to teach (and good at teaching), have confidence in yourself and your abilities, and be good at networking.