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

1. 1. If you prescribe midazolam 5 mg routinely for terminal agitation then you are wrong.
      Do say – try to use a dose that works first time.
      Don’t say – but 5mg just feels safer.
   2. Palliating people is not an ok phrase, even in the notes.
      Do say – do you mean that you’ve recognised dying despite all best efforts to the contrary?
      Don’t say – palliating is just jargon for dying- jargon for dying is ‘DYING’.
   3. Antibiotics are rarely helpful in the last days and hours.
      Do say – shall we focus on the important things?
      Don’t say – continue whilst the cannulae is in situ.
   4. Specialist palliative care is most helpful when introduced earlier.
      Do say – I think we should introduce our colleague so that they can support you whilst we also try what we can.Don’t say – we still have options so they aren’t ready for palliative care yet.
   5. Prognosis is never certain, even when it seems so.
      Do say – if things continue as they have been then time is likely to be measured in (insert range).
      Don’t say – they won’t survive the weekend.
   6. Informing people that they are dying is not optional.
      Do say – how would you like me to talk about your health?
      Don’t say – obs are stable -you know who you are.
   7. Using weak and strong opioids together is bad pharmacology.
      Do say – let’s try and use one opioid-it’ll be easier for you to manage and do everything.
      Don’t say – codeine and oxycodone? Why not? (You know why not, don’t pretend otherwise). 
   8. Use specific language, like dying, misunderstanding causes more complaints than any other issue.
      Do say – I’m sorry, I believe that you are going to die of your disease.
      Don’t say – your condition is deteriorating.
   9. Tramadol is a bad drug.
      Do say – Tramadol Bad.
      Don’t say – literally anything else about Tramadol; it’s a naughty drug and needs some very long time out. 
   10. Dying generally gets better when we de-medicalise the process.
       Do say – less is more.
       Don’t say – I’ll just continue the statin. Always stop the statin. Always.

Note by the author- this is a humorous article presented in the style of popular BuzzFeed and similar articles and I hope brings a little joy to the reader. If any offence is taken, please know that isn’t my intention and I hope you’re able to see the funny side.

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