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Key points
  • Sometimes palliative care can be challenging. Issues that may be hard for GPs to deal with include:
    • Clinical anxieties eg, if there is a perception that a diagnosis was missed or delayed
    • Difficulty in working out how and when to switch from a curative to palliative approach 
    • Feelings of reluctance to take on complex problems because of time constraints in general practice
    • Difficulty dealing with clinical uncertainty
    • Feelings of clinical helplessness if unable to completely relieve the distress of a patient or family, or feeling that an outcome was unacceptable
    • Being involved in caring for a dying friend, colleague, or family member 
    • Caring for a patient with whom one identifies in some way.
  • In a busy general practice setting it is common for GPs to 'soldier on' despite a level of distress. However, accumulating stressors can lead over time to burnout which:
    • Affects wellbeing and relationships
    • Impacts on workplace and colleagues
    • May reduce the quality of the care the GP is able to provide.
  • Useful clinical strategies for professional self-care to reduce the risk of burnout include:
    • Recognising that all doctors will sometimes be troubled by difficult cases
    • Sharing care with others, or referring on, if there are 'boundary issues' or strong feelings involved
    • Accepting the limits of the care that can be provided within the constraints of a busy general practice, and not setting unrealistic expectations - sharing care may be helpful here
    • Discussing a difficult case with a trusted colleague or a member of the palliative care team - this can be very reassuring, even quite some time later.

Tools and Resources for professionals

For GPs involved in palliative care - Information about burn out and self-care
Things to think about, information, and resources

General information about doctors’ wellbeing, emotional health and burnout
From: The Royal Australian College of General Practitioners (RACGP)
Ref: The Royal Australian College of General Practitioners (RACGP). The conspiracy of silence: emotional health among medical practitioners. South Melbourne: The RACGP; 2004.
From: Centre for Health Research & Psycho-oncology (CHeRP)
Ref: Girgis A, Hansen V. Prevalence and predictors of burnout in the COSA oncology workforce. CHeRP, University of Newcastle, NSW; December 2007.

Issues of particular relevance in palliative care
Awareness of one’s own vulnerabilities is important for doctors
From the Palliative Care Network of Wisconsin Fast Facts
From the New York Magazine
Discussion about how doctors cope with the deaths of their patients and of different coping strategies
Ref: Wolpin BM, Chabner BA, Lynch TJ Jr, Penson RT. Learning to cope: how far is too close? Oncologist. 2005 Jun-Jul;10(6):449-56.
(82kb pdf)
Discussion about the challenges of maintaining hope for both doctors and patients
Ref: Penson RT, Gu F, Harris S, Thiel MM, Lawton N, Fuller AF Jr, et al. Hope. Oncologist. 2007 Sep;12(9):1105-13.

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Last updated 14 February 2017*