Article by Dr Margo Hoekstra, GP and representative on the Mental Health Advisory Committee

Dying mostly is a hard passage. As GPs we can help sometimes. Often it is a note from the hospital or a call from a family member to tell us our patient has died. If it is true that 80% of people want to die at home but only 20% achieve this there is something wrong with the system of which we are a part.

The role of the palliative care services in the inner west has been a mystery to me for some time and so I took the opportunity to do a 3 day clinical attachment with PEPA (Program of Experience in the Palliative Approach). My hope was to understand how the service works in our area and also to get more insight into symptom management.

The first objective was achieved and I have also gained some interesting insights into symptom management not least the unusual uses of medications such as ranitidine for itch and haloperidol for nausea.

Palliative care in our community is largely a specialist nursing based service with CNCs and CNSs overseeing the care needed by people at home. In the absence of adequate community medical specialist services there is a big role for GPs to become part of the community support structure if we are to support the majority of the patients who want to die at home to do so.

I would like to see CSGPN take a more active role in setting up a program whereby the GP can find a way into providing this support and working more closely with the services that are there. Of all the specialties, Palliative care is most suited to General Practice, and not least because we have been looking after our patients for a long time and know their family and social situation. I will pursue this but in the mean time you too could do a PEPA attachment via their website: http://www.pepaeducation.com/GPs/

Palliative Care is a symptom management focused service which regards end of life stage processes as a challenge to ensure good care (quality of life), not a defeat that all has been done to help the patient. Most Specialist services continue to work towards cure and regard the acceptance that there is no cure as a defeat. Most specialists are still not good at making patients aware of the realistic outcomes of treatments for potentially fatal illnesses. This may be VERY slowly changing as Palliative Care Specialists are called upon in our major hospitals to manage difficult symptoms especially those which cross specialist boundaries (eg. GIT symptoms in renal patients) or involve pain that other pain specialties which focus on the ‘well’ patient deal with.

Yes, that was one of the most interesting observations - Palliative Care physicians increasingly are called upon to manage renal patients, patients with end stage respiratory disease as well as the more traditional cancer patients. They can be involved with patients for months, even years; there are outpatient clinics which follow up people for long periods.

As GPs we can be assured to have the support of the specialist nurse and we have access to these outpatient clinics.