20 OPINION
20 OPINION
16 MAY 2025 ausdoc. com. au
Insight
My message to doctors
Dr Rod Watson GP in Newcastle, NSW.
Step up, not away, as your patients reach their end.
ONCE upon a time, a wiser, older and more silvery fox than I began to dabble in the newly recognised area of palliative care.
Previously, the care of these patients had been left to nurses and forgotten medical wards at the rear of public hospital grounds.
This more mature GP made
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himself a regional expert in the field simply by concentrating on this area of his general practice and by liaising with the solitary tertiary palliative care specialist.
He would consult with the local medical specialists, who supervised the admissions in the local public hospital to stabilise these patients.
He would provide consultation and management strategies, drawing on his prior knowledge of these patients and their families’ concerns.
I could see, as a less experienced GP, the effort he applied to these seemingly hopeless tasks. I could not then comprehend the attention he bestowed on his endof-life patients.
Fast forward 25 years and now
I am the silver fox of our general practice.
I now realise that the medical management in these last months, weeks and days of our patients’ lives is nuanced and skilful.
Equally, it is well respected by the patients and much appreciated by their families.
I find that discussions regarding prognosis in terminal care are often skimmed over by the oncologists and the surgeons while the palliative care team is yet to visit the patient.
If no prognosis has been discussed, this is an opportunity for the GP to step in and do so, if the patient agrees.
Retaining your role as the patient’ s primary carer at this stage is vital for the patient – doctor relationship.
It is rewarding work and greatly appreciated, and well within a GP’ s skill set.
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I find that discussions regarding prognosis in terminal care are often skimmed over.
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However, as I well remember as a younger doctor, this ongoing role seems to be less embraced by many colleagues.
On reflection over my long career, my advice is not to fall away from this area of healthcare as your patients decline.
Stay in the circle of care by trying to keep abreast of the prescribing, liaising with the palliative care team, using the telehealth options, and ringing the pharmacist to check on narcotic dose changes during the last admission.
Stay as the central person in the management of your dying patients. Your depth of practice will improve, and your patients and their families will feel the benefits.
It makes this silver fox purr when a younger colleague stops to discuss and seek my advice on the management of their dying patients rather than the correct statin dose for a healthy middle-aged person.
My previously mentioned older and wiser GP friend and associate is now in aged care himself.
How the wheel forever turns.