Domhnall MacAuley: Death and youth

Domhnall MacauleyDoctors took a long time to recognise that people die. We are no longer afraid to talk about “end of life care.” And, a large number turned up to an 8am fringe meeting run by the RCGP Scotland end of life care subgroup at the RCGP-SAPC Primary Care conference.

Lots of ideas are introduced with the best intentions. Communication between professionals is essential but there was now excessive form filling to the point where a dying patient may have three sets of records. Asked to identify barriers to good care, the audience were particularly frustrated by how process could get in the way of good care. 

Palliative care teams seem like a good idea but GPs found it difficult when, having cared for someone for a lifetime, they were expected to hand over to a palliative are team to manage their death. The change of category grated—the transition from good general practice to palliative care. Good care may not always mean a change in care.

Making a decision to mark notes “Do not resuscitate” seems like a good idea. But, the term has negative implications, suggesting to patients that there was something that could be done that wouldn’t be done. It might be better that we talk about, and mark notes, to say:  “Allow natural death”

Dying at home also seems like a good idea. Sue Kinsey, a patient member of the panel, commented that, while many people worry about leaving their dog at home throughout the day when they are at work, there was little thought of older people living alone with a terminal illness who might have just two twenty minute visits by a district nurse daily. There are times when it may be better to die in hospital.

The morning started with death and the afternoon ended with youth. It was lovely to be reminded of the great achievements of Ann McPherson in this inaugural memorial lecture in her name. The lecture by Professor Sir Al Aynsley-Green, the former Children’s Commissioner for England encouraged us to think about children. But, it was Ann’s insights from her lifetime as a family doctor that resonated so much with GPs and her brilliance was in articulating all our experiences of caring for adolescent health problems. General practice from youth to old age. Its what we do.

Domhnall MacAuley is primary care editor, BMJ