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Mark Taubert: Palliative care—a “depressing” specialty?

14 Oct, 13 | by BMJ

mark_taubertAs part of the Dying Matters Awareness Week in the UK, we were all encouraged to talk openly about dying in an attempt to be more ready for it. [1] This is something that those working in specialties like palliative care encourage and embrace. But are we truthfully that willing to talk more about our working lives and what this entails when we are away from work? A palliative care nurse recently told me that she tried to avoid having conversations about her day job when she met people socially, because too often when she had gone into more detail she either got stuck in very heavy conversations and debates or would end up giving bereavement counselling.

What some of us in this line of profession are perhaps less ready for, is the following questions, when we are caught unawares or are meeting new people. Imagine you are at a wedding, or a charity event and have sat down next to complete strangers and are forced into a small talk situation.

“What job do you do?”

“I’m a doctor”

“What sort of doctor?”

“I’m a palliative care doctor.”

“What’s that? Palli… what?”

“We treat people who are dying and terminally ill. Our specialty deals with people in the last years of life, and we try to improve the quality of their living, focussing on what is important in the time that remains.”

“Oh, no that’s depressing…I don’t know how you can do that, I could never do that! How do you do it?”

“Well, it’s not all that depressing really, we actually focus on the positives, build relationships, and set our goals diff…”

“Oh but it must be depressing, it’s just so awful…I don’t know how you do it? It must be a horrible job to have to do!”

The above conversation is one that many people working in healthcare, especially in oncology, palliative care, and hospices may be able to relate to. It depends of course on many things, and some of us are more skilful at traversing this potential minefield than others. I’m not. When people I have just met ask me what I do, I try to be careful how I phrase things appropriately to the given situation, but my adeptness can really vary.

Why is it then that palliative care, oncology, and hospice jobs do not readily afford their workers with a “get-out-of-job-conversations-swiftly card?” Especially given the fact that we are often quite outspoken about matters relating to death and dying in our work lives?

The answer is multi-faceted. Often, several thought processes happen at once, when the words palliative or hospice, or cancer, or any terminal illnesses for that matter have been mentioned in conversation. Firstly, there is for some a real expectation that such jobs must be depressing due to their proximity with advanced illness and dying, and therefore saying you “enjoy” your work can feel wrong or inappropriate within that context. Secondly, people will usually remember and sometimes recount stories about loved-ones in their own lives who have passed away. So getting into such depth can be quite a challenge during the first few minutes of a first encounter.

Job satisfaction rates in palliative care among physicians remain very good, with a high likeliness of physicians recommending a job in hospice or palliative medicine to others. [2] Burn out among palliative care physicians seems to be consistently lower compared with burnout for those working in other specialties. [3,4,5]

In his book The pleasures and sorrows of work, the writer Alain de Botton travels across the planet to investigate different types of professions and seeks to find what makes them fulfilling or soul-destroying. Work, as he finds, is for many spent in occupations chosen by their unthinking, 16 year old selves. To some degree this is correct for medicine also. However, many healthcare professionals make their more detailed, “thinking” career decisions later on in their mid 20s. De Botton concludes that work, whatever we eventually end up doing, helps keep at bay the intrinsic knowledge of how brief our lives all are. This is a striking observation, in particular if applied to the context of palliative care workers, who actually get a daily reminder of the brevity and frailty of existence.

But what the public may be surprised about is that a lot of hospice, cancer, and palliative care settings encourage laughter. In fact humour is often initiated by patients themselves, [6] and some settings have laughter workshops. [7] What makes our working lives enjoyable is thinking outside the box and helping patients and their loved ones focus on other important achievements in life: being pain free to go for a walk outside, getting to one last Six Nations rugby match to beat the English, finishing a book of poetry, getting married, sorting out an adaptable wheelchair and a syringe-driver to help someone go to a Donny Osmond concert, or speaking to their mother who they have been estranged from for 17 years. All this makes jobs that involve working with people who are approaching the end of their lives well worth shouting about. So next time someone asks you what you do, be brave and really go for it. You will risk turning small-talk into “major-talk,” but you may leave an impression on what we really do and change some preconceptions.

Competing Interests:  I declare that that I have read and understood the BMJ Group policy on declaration of interests and I have no relevant interests to declare.

Mark Taubert is a palliative care consultant at University Hospital Llandough and Velindre Cancer Centre in Cardiff. He has a number of interests, including how social media impact on palliative care and how Cardiff City FC are faring. His Twitter is @DrMarkTaubert

References:

1. Dying Matters (accessed 10/06/2013)

2. American Academy of Hospice and Palliative Medicine. Physician Compensation and Benefits Survey—2010 Report. Glenview, IL: American Academy of Hospice and Palliative Medicine; 2011.

3. Lepnurm R, Lockhart WS and Keegan D. A measure of daily distress in practising medicine. Can J Psychiatry 2009; 54: 170–80.

4. Asai M, Morita T, Akechi T, et al. Burnout and psychiatric morbidity among physicians engaged in end-of-life care for cancer patients: cross-sectional nationwide survey in Japan. Psychooncology 2007; 16: 421–8.

5. Dunwoodie D and Auret K. Psychological morbidity and burnout in palliative care doctors in Western Australia. Int Med J 2007; 37: 693–8.

6. Adamle KN, Ludwick R Humor in hospice care: Who, where and how much? American Journal of Hospice and Palliative Medicine Jul 2005; Vol 22; no 4

7. Northumberland Cancer Support Group- Laughter workshop (accessed 22/07/2013)

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  • Sarah Scott Baker

    Hi Mark, I hope you don’t mind but I’ve shared your post with my work colleagues here in Peninsula Home Hospice, Victoria, Australia. I’m sure they will find it an interesting read as I have. I remember your presentation in Gregynog in 2008! I used to work for Dr Andy Fowell and helped Ros with the conference. Best wishes, Sarah

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