It seems to me, as time goes by, that medicine becomes more and more fragmented. We don’t seem to consider our patients as a whole person anymore. Instead, our patients become disease entities, and the clinical approach is to treat the disease and to “tick the box” with their treatment. Has the asthma plan been done? Have we completed the diabetes cycle of care? What about their cardiovascular risk?
This may be a scientific approach to medicine, and don’t get me wrong: it certainly does help with managing particular diseases, but there is an art to medicine as well. The art of medicine is where we engage with our patient, developing a trusting and a therapeutic relationship. We celebrate their joys with them, commiserate during sad times, and become an important focus in their lives. We consider our patient, not just as a physiological being, but as a human being that lives within a family and within a community. We become their doctor.
We also age with our patients, a truism that holds today as it did a century ago. And as our patients age, they die. This is inevitable. We know that. As the patient becomes aware of their decline, they come to know that as well. This, then, can be a challenging time for both the doctor and the patient. How do you help prepare a patient for their death? What do you say? What do you do? What should you focus on? Where do you turn for advice?
This is where the End-of-Life Clinical Audit, developed by the Australian and New Zealand Society of Palliative Medicine through Decision Assist, is so helpful. The Audit is designed to help answer these questions, giving the doctor the tools, understanding and insight to discuss these matters with their patient. The Audit gives a framework and a timeline for engaging with the patient and their family. It combines intellectual rigour with practical advice for all stages of the patient’s decline. It is also rewarding: it allows you to engage in the art of medicine, bringing comfort for your patient.
I found completing the Audit fitted neatly within my practice. I learnt many things from it - practical ideas that I have incorporated into my daily routine. Our older patients face many challenges as they age, and this Audit helps us to preserve their dignity and maintain compassion in the face of their dying. I certainly recommend this audit for all GPs.
To learn more:
- Read more about the accredited clinical audit that will enable you to improve your delivery of end-of-life care to older Australians.
- Undertake an accredited online education module about a framework of care to support proactive management of older patients with advanced progressive life-limiting conditions.
Dr David Healey (B Med, MPallC, FRACGP) is a rural GP in Taree, NSW.