{"id":2132,"date":"2024-07-12T09:00:28","date_gmt":"2024-07-12T09:00:28","guid":{"rendered":"https:\/\/blogs.bmj.com\/spcare\/?p=2132"},"modified":"2024-07-11T13:58:23","modified_gmt":"2024-07-11T13:58:23","slug":"10-golden-rules-of-palliative-care-on-how-to-manage-a-dying-person-youll-never-guess-number-4","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/spcare\/2024\/07\/12\/10-golden-rules-of-palliative-care-on-how-to-manage-a-dying-person-youll-never-guess-number-4\/","title":{"rendered":"10 Golden rules of palliative care on how to manage a dying person – you\u2019ll never guess number 4!"},"content":{"rendered":"

By Dr Joseph Hawkins, Consultant in Palliative Medicine, Clinical lead for End of Life Care, Ashford and St Peter\u2019s NHS Foundation Trust. Twitter: @JoeHawk75825077<\/em><\/p>\n

\"Photo<\/p>\n

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    1. If you prescribe midazolam 5 mg routinely for terminal agitation then you are wrong.
      \n<\/strong>Do say – try to use a dose that works first time.
      \nDon\u2019t say – but 5mg just feels safer.<\/li>\n
    2. Palliating people is not an ok phrase, even in the notes.
      \n<\/strong>Do say – do you mean that you\u2019ve recognised dying despite all best efforts to the contrary?
      \nDon\u2019t say – palliating is just jargon for dying- jargon for dying is \u2018DYING\u2019.<\/span><\/li>\n
    3. Antibiotics are rarely helpful in the last days and hours.
      \n<\/strong><\/strong>Do say – shall we focus on the important things?
      \nDon\u2019t say – continue whilst the cannulae is in situ.<\/li>\n
    4. Specialist palliative care is most helpful when introduced earlier.
      \n<\/strong><\/strong>Do say – I think we should introduce our colleague so that they can support you whilst we also try what we can.Don\u2019t say – we still have options so they aren\u2019t ready for palliative care yet.<\/li>\n
    5. Prognosis is never certain, even when it seems so.
      \n<\/strong><\/strong>Do say – if things continue as they have been then time is likely to be measured in (insert range).
      \nDon\u2019t say – they won\u2019t survive the weekend.<\/li>\n
    6. Informing people that they are dying is not optional.
      \n<\/strong><\/strong>Do say – how would you like me to talk about your health?
      \nDon\u2019t say – obs are stable -you know who you are.<\/li>\n
    7. Using weak and strong opioids together is bad pharmacology.
      \n<\/strong><\/strong>Do say – let\u2019s try and use one opioid-it\u2019ll be easier for you to manage and do everything.
      \n<\/span>Don\u2019t say – codeine and oxycodone? Why not? (You know why not, don\u2019t pretend otherwise).\u00a0<\/span><\/li>\n
    8. Use specific language, like dying, misunderstanding causes more complaints than any other issue.
      \n<\/strong><\/strong>Do say – I\u2019m sorry, I believe that you are going to die of your disease.
      \n<\/span>Don\u2019t say – your condition is deteriorating.<\/span><\/li>\n
    9. Tramadol is a bad drug.
      \n<\/strong><\/strong>Do say – Tramadol Bad.
      \nDon\u2019t say – literally anything else about Tramadol; it\u2019s a naughty drug and needs some very long time out.\u00a0<\/span><\/li>\n
    10. Dying generally gets better when we de-medicalise the process.
      \n<\/strong><\/strong>Do say – less is more.
      \n<\/span>Don\u2019t say – I\u2019ll just continue the statin. Always stop the statin. Always.<\/span><\/li>\n<\/ol>\n<\/li>\n<\/ol>\n
        \n
      1. <\/li>\n<\/ol>\n

        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\u2019t my intention and I hope you\u2019re able to see the funny side.<\/p>\n

        Also by this Author:<\/p>\n

        The ink is dry<\/a>
        \n        Don’t stare at the light<\/a>
        \n        Preparing for the apocalypse<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

        By Dr Joseph Hawkins, Consultant in Palliative Medicine, Clinical lead for End of Life Care, Ashford and St Peter\u2019s NHS Foundation Trust. Twitter: @JoeHawk75825077   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\u2019t say – but […]<\/p>\n

        Read More…<\/a><\/p>\n","protected":false},"author":470,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-2132","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/spcare\/wp-json\/wp\/v2\/posts\/2132","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/spcare\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/spcare\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/spcare\/wp-json\/wp\/v2\/users\/470"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/spcare\/wp-json\/wp\/v2\/comments?post=2132"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/spcare\/wp-json\/wp\/v2\/posts\/2132\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/spcare\/wp-json\/wp\/v2\/media?parent=2132"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/spcare\/wp-json\/wp\/v2\/categories?post=2132"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/spcare\/wp-json\/wp\/v2\/tags?post=2132"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}