To palliate or not to palliate.

By Dr Joseph Hawkins, Consultant in Palliative Medicine, Clinical lead for End of Life Care, Ashford and St Peter’s NHS Foundation Trust. Twitter: @JoeHawk75825077

The year is 2030.

It all started with the most innocuous of phrases: ‘palliation’. A simplified way of saying that someone was dying. At least that’s what everyone thought. Of course language shapes thought and thought leads to deed. So it was that palliation, to palliate, they were palliated became official terms, a part of a lexicon enshrined in medical practice and terminology.

Soon the jargonistic term palliate was honoured by a national day of palliation. On this day it became custom for those who had experienced bereavement to stand outside their houses, banging pots and grinning manically at their neighbours. So much was this celebrated that it was standard practice for Prime Ministers to stand outside of number 10 taking part; their photographs an annual front page reminder of palliation day. It was even considered good luck to die on this day-families often requesting that ventilators and antibiotics be kept on until the national holiday.

The voices of those who worked in what was known as palliative care soon became subsumed behind an agenda for a clearer view of life and dying. Catchphrases that neatly summed-up a complicated state were the way forward, scientifically accurate statements of complex ambiguity were out. The public want to understand dying and they no-longer trust the science, was the message. Dying should henceforth be known as palliation-a kinder phrase, it was said. Those that worked in palliative care were soon issued with new uniforms, a dark tunic with a discrete ‘P’ upon the breast pocket and a padded shoulder for support of head tilting and of course hugs.

When a person was recognised as dying the previously difficult discussions became a thing of the past. A barbaric attempt to explain what no-one felt needed an explanation. Instead the medical team would step forward and utter: “we are afraid that it is palliative now, we are palliating. The palliators will now take over”. Medical students were issued with a prepared script that became the norm for all doctors of the future. Indeed, the script become an expectation to the extent that the sight of a doctor pulling out a laminated piece of paper became the foreboding of bad news to come.

The efforts to make dying easier to understand and more accessible as a ‘diagnosis’1 became such a success that executive leaders in every medical field called for their own similar foreshortening of language. The consensus was in: communication was overrated and inhibited the goal of getting on with the job of being a doctor. It wasn’t that people didn’t wish to talk to patients, they just wanted it made into a simpler endeavour-after all, the majority of complaints stemmed from communication. This foreshortening of confabulating terms into those of vapid vacuosity, delivered with vim and vigour could only be a good thing.

Within a few years a string of new verbs had sprung forth from the world of closed meetings to the ears of the general public with nary a thought in between. Soon it was understood that if you had a chest problem you were being respirated under the resp team. This would cover everything from asthma to lung cancer and so it was understood that a bad respirator admission was probably a problem for the patient concerned but without the need to worry them with specifics such as a diagnosis. To oncate was to be seen by the oncaters or cancer specialists, to cardate was to be seen by the card team (or cardiologists in old-speak), and to be boned was a briefly popular past-tense verb for orthopaedic procedures although it was eventually formalised as having bone correction by the boner team, a slight improvement.

It is 2023, not the dystopia of 2030 described above. Putting aside a little hyperbole there are lessons in this blog, let’s hope we learn them as a profession and as a society, soon.

References.

1. https://blogs.bmj.com/spcare/2021/12/15/how-to-tell-if-your-patient-is-dying/

Also by this author:

Diagnosing Dying
Creative Distress
Why Being Clever Isn’t Always Very Clever

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