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.

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: DRS4DRS is a subsidiary of the AMA
This website promotes the health and wellbeing of doctors and medical students across Australia.

The conspiracy of silence: Emotional health among medical practitioners
From: The Royal Australian College of General Practitioners (RACGP)
Ref: Clode D. The conspiracy of silence: emotional health among medical practitioners. South Melbourne, VIC: Royal Australian College of
General Practitioners; 2004.

Prevalence and predictors of burnout in the COSA oncology workforce (289kb pdf)
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

Confronting personal mortality
Awareness of one’s own vulnerabilities is important for doctors
From: Palliative Care Network of Wisconsin Fast Facts

'The Day I Started Lying to Ruth: A cancer doctor on losing his wife to cancer' 
On the experience of personal loss as a doctor
From: New York Magazine

Learning to cope: how far is too close?
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.

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.

Last updated 21 February 2017