{"id":24154,"date":"2013-01-30T08:24:25","date_gmt":"2013-01-30T07:24:25","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=24154"},"modified":"2013-01-30T08:24:25","modified_gmt":"2013-01-30T07:24:25","slug":"domhnall-macauley-the-silent-cost-of-caring","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2013\/01\/30\/domhnall-macauley-the-silent-cost-of-caring\/","title":{"rendered":"Domhnall MacAuley: The silent cost of caring"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" alt=\"Domhnall Macauley\" src=\"http:\/\/www.bmj.com\/site\/blog\/icons\/domhnall.jpg\" width=\"162\" height=\"110\" align=\"left\" \/>As he hung up his coat at the end of the morning, he stunned his nursing and junior colleagues: \u201cI will be glad when I don\u2019t have to do that clinic anymore.&#8221; It was a cancer clinic in a non cancer speciality. Everyone in outpatients thought he was wonderful; a caring clinician, a good listener with time for everyone, and great with patients in many difficult circumstances.\u00a0 He seemed to take it in his stride, everyone enjoyed working with him, a superb role model, and no one ever noticed that he found it difficult. He never said anything.<!--more--><\/p>\n<p>Relentless, draining, wearing. The daily, weekly, yearly ebb and flow of ill health through the surgery door. A job where every day is different means that every day is a challenge.\u00a0 In specialist medicine the pressures are easier to see\u2014in general practice, trivialities deceive, but every cough could be cancer, and every minor complaint the undifferentiated prelude to significant illness. Hidden among the minor and self limiting are the serious and life ending. Everyone dies, and almost everyone sees their doctor first.<\/p>\n<p>In palliative care there are no happy endings. Those committed will tell you there is no job more rewarding than sharing someone\u2019s last illness. But, aspiring to ease patients on life\u2019s last journey, the rewards must always be relative. No problems solved, treated, or cured. A good death. I admire my palliative care colleagues and appreciate their tough role. But, no one can give forever. Every day testing the ability to recover.\u00a0 Endlessly draining, they must eventually come to the bottom of the tank.<\/p>\n<p>The better the doctor\u2014the more caring, compassionate, empathetic, and generous\u2014the greater the price. Just three examples from different parts of healthcare. Maybe medicine should begin to talk about this.<\/p>\n<p><strong>Domhnall MacAuley<\/strong> is primary care editor,<em> BMJ.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>As he hung up his coat at the end of the morning, he stunned his nursing and junior colleagues: \u201cI will be glad when I don\u2019t have to do that [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2013\/01\/30\/domhnall-macauley-the-silent-cost-of-caring\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1287],"tags":[],"class_list":["post-24154","post","type-post","status-publish","format-standard","hentry","category-domhnall-macauley"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Domhnall MacAuley: The silent cost of caring - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2013\/01\/30\/domhnall-macauley-the-silent-cost-of-caring\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Domhnall MacAuley: The silent cost of caring - The BMJ\" \/>\n<meta property=\"og:description\" content=\"As he hung up his coat at the end of the morning, he stunned his nursing and junior colleagues: \u201cI will be glad when I don\u2019t have to do that [...]More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/bmj\/2013\/01\/30\/domhnall-macauley-the-silent-cost-of-caring\/\" \/>\n<meta property=\"og:site_name\" content=\"The BMJ\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/bmjdotcom\/\" \/>\n<meta property=\"article:published_time\" content=\"2013-01-30T07:24:25+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/www.bmj.com\/site\/blog\/icons\/domhnall.jpg\" \/>\n<meta name=\"author\" content=\"BMJ\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@bmj_latest\" \/>\n<meta name=\"twitter:site\" content=\"@bmj_latest\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"BMJ\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2013\\\/01\\\/30\\\/domhnall-macauley-the-silent-cost-of-caring\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2013\\\/01\\\/30\\\/domhnall-macauley-the-silent-cost-of-caring\\\/\"},\"author\":{\"name\":\"BMJ\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\"},\"headline\":\"Domhnall MacAuley: The silent cost of caring\",\"datePublished\":\"2013-01-30T07:24:25+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2013\\\/01\\\/30\\\/domhnall-macauley-the-silent-cost-of-caring\\\/\"},\"wordCount\":313,\"commentCount\":1,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2013\\\/01\\\/30\\\/domhnall-macauley-the-silent-cost-of-caring\\\/#primaryimage\"},\"thumbnailUrl\":\"http:\\\/\\\/www.bmj.com\\\/site\\\/blog\\\/icons\\\/domhnall.jpg\",\"articleSection\":[\"Domhnall MacAuley\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2013\\\/01\\\/30\\\/domhnall-macauley-the-silent-cost-of-caring\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2013\\\/01\\\/30\\\/domhnall-macauley-the-silent-cost-of-caring\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2013\\\/01\\\/30\\\/domhnall-macauley-the-silent-cost-of-caring\\\/\",\"name\":\"Domhnall MacAuley: The silent cost of caring - The BMJ\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2013\\\/01\\\/30\\\/domhnall-macauley-the-silent-cost-of-caring\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2013\\\/01\\\/30\\\/domhnall-macauley-the-silent-cost-of-caring\\\/#primaryimage\"},\"thumbnailUrl\":\"http:\\\/\\\/www.bmj.com\\\/site\\\/blog\\\/icons\\\/domhnall.jpg\",\"datePublished\":\"2013-01-30T07:24:25+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2013\\\/01\\\/30\\\/domhnall-macauley-the-silent-cost-of-caring\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2013\\\/01\\\/30\\\/domhnall-macauley-the-silent-cost-of-caring\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2013\\\/01\\\/30\\\/domhnall-macauley-the-silent-cost-of-caring\\\/#primaryimage\",\"url\":\"http:\\\/\\\/www.bmj.com\\\/site\\\/blog\\\/icons\\\/domhnall.jpg\",\"contentUrl\":\"http:\\\/\\\/www.bmj.com\\\/site\\\/blog\\\/icons\\\/domhnall.jpg\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2013\\\/01\\\/30\\\/domhnall-macauley-the-silent-cost-of-caring\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Domhnall MacAuley: The silent cost of caring\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#website\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\",\"name\":\"The BMJ\",\"description\":\"Helping doctors make better decisions.\",\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\",\"name\":\"The BMJ\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2018\\\/05\\\/The-BMJ-logo.jpg\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2018\\\/05\\\/The-BMJ-logo.jpg\",\"width\":852,\"height\":568,\"caption\":\"The BMJ\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/logo\\\/image\\\/\"},\"sameAs\":[\"https:\\\/\\\/www.facebook.com\\\/bmjdotcom\\\/\",\"https:\\\/\\\/x.com\\\/bmj_latest\"]},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\",\"name\":\"BMJ\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"caption\":\"BMJ\"},\"sameAs\":[\"https:\\\/\\\/blogs.bmj.com\\\/\"],\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/author\\\/admin\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Domhnall MacAuley: The silent cost of caring - The BMJ","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blogs.bmj.com\/bmj\/2013\/01\/30\/domhnall-macauley-the-silent-cost-of-caring\/","og_locale":"en_US","og_type":"article","og_title":"Domhnall MacAuley: The silent cost of caring - The BMJ","og_description":"As he hung up his coat at the end of the morning, he stunned his nursing and junior colleagues: \u201cI will be glad when I don\u2019t have to do that [...]More...","og_url":"https:\/\/blogs.bmj.com\/bmj\/2013\/01\/30\/domhnall-macauley-the-silent-cost-of-caring\/","og_site_name":"The BMJ","article_publisher":"https:\/\/www.facebook.com\/bmjdotcom\/","article_published_time":"2013-01-30T07:24:25+00:00","og_image":[{"url":"http:\/\/www.bmj.com\/site\/blog\/icons\/domhnall.jpg","type":"","width":"","height":""}],"author":"BMJ","twitter_card":"summary_large_image","twitter_creator":"@bmj_latest","twitter_site":"@bmj_latest","twitter_misc":{"Written by":"BMJ","Est. reading time":"2 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/bmj\/2013\/01\/30\/domhnall-macauley-the-silent-cost-of-caring\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2013\/01\/30\/domhnall-macauley-the-silent-cost-of-caring\/"},"author":{"name":"BMJ","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe"},"headline":"Domhnall MacAuley: The silent cost of caring","datePublished":"2013-01-30T07:24:25+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2013\/01\/30\/domhnall-macauley-the-silent-cost-of-caring\/"},"wordCount":313,"commentCount":1,"publisher":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#organization"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2013\/01\/30\/domhnall-macauley-the-silent-cost-of-caring\/#primaryimage"},"thumbnailUrl":"http:\/\/www.bmj.com\/site\/blog\/icons\/domhnall.jpg","articleSection":["Domhnall MacAuley"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/blogs.bmj.com\/bmj\/2013\/01\/30\/domhnall-macauley-the-silent-cost-of-caring\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/bmj\/2013\/01\/30\/domhnall-macauley-the-silent-cost-of-caring\/","url":"https:\/\/blogs.bmj.com\/bmj\/2013\/01\/30\/domhnall-macauley-the-silent-cost-of-caring\/","name":"Domhnall MacAuley: The silent cost of caring - The BMJ","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#website"},"primaryImageOfPage":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2013\/01\/30\/domhnall-macauley-the-silent-cost-of-caring\/#primaryimage"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2013\/01\/30\/domhnall-macauley-the-silent-cost-of-caring\/#primaryimage"},"thumbnailUrl":"http:\/\/www.bmj.com\/site\/blog\/icons\/domhnall.jpg","datePublished":"2013-01-30T07:24:25+00:00","breadcrumb":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2013\/01\/30\/domhnall-macauley-the-silent-cost-of-caring\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.bmj.com\/bmj\/2013\/01\/30\/domhnall-macauley-the-silent-cost-of-caring\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/bmj\/2013\/01\/30\/domhnall-macauley-the-silent-cost-of-caring\/#primaryimage","url":"http:\/\/www.bmj.com\/site\/blog\/icons\/domhnall.jpg","contentUrl":"http:\/\/www.bmj.com\/site\/blog\/icons\/domhnall.jpg"},{"@type":"BreadcrumbList","@id":"https:\/\/blogs.bmj.com\/bmj\/2013\/01\/30\/domhnall-macauley-the-silent-cost-of-caring\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/blogs.bmj.com\/bmj\/"},{"@type":"ListItem","position":2,"name":"Domhnall MacAuley: The silent cost of caring"}]},{"@type":"WebSite","@id":"https:\/\/blogs.bmj.com\/bmj\/#website","url":"https:\/\/blogs.bmj.com\/bmj\/","name":"The BMJ","description":"Helping doctors make better decisions.","publisher":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/blogs.bmj.com\/bmj\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/blogs.bmj.com\/bmj\/#organization","name":"The BMJ","url":"https:\/\/blogs.bmj.com\/bmj\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/logo\/image\/","url":"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/05\/The-BMJ-logo.jpg","contentUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/05\/The-BMJ-logo.jpg","width":852,"height":568,"caption":"The BMJ"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.facebook.com\/bmjdotcom\/","https:\/\/x.com\/bmj_latest"]},{"@type":"Person","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe","name":"BMJ","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","caption":"BMJ"},"sameAs":["https:\/\/blogs.bmj.com\/"],"url":"https:\/\/blogs.bmj.com\/bmj\/author\/admin\/"}]}},"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/24154","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/comments?post=24154"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/24154\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/media?parent=24154"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/categories?post=24154"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/tags?post=24154"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}