Dr Thea van de Mortel

Trialling the use of GP registrars to help manage patients accessing community palliative care services has shown promising results, writes Dr Thea van de Mortel, a member of the collaborative team comprising Northern NSW Local Health District, the North Coast Medicare Local, North Coast GP Training and Griffith University.

Recent estimates at both a state and national level suggest that demand for palliative care services will continue to rise by about 5% per year, given both the ageing population and the increase in rates of chronic disease. Effective community palliative care services reduce the need for hospital admissions and support patients in their choice to be cared for at home.

However, the majority of Australians, while preferring to die at home, actually die in hospital. Palliative care patients are often admitted to hospital for symptom management and once admitted have a length of stay that is four times the mean duration of stay for patients generally.

Book Review - Reviewed by Robin Osborne

Being Mortal
Atul Gawande
(Profile Books 282 pp)

In an earlier review I described Atul Gawande’s The Checkist Manifesto as required reading for those in the medical profession or any line of work that entails identified outcomes, team work and the serious consequences, professional or financial, of error.

The same may be said of this discussion of end-of-life issues, which he encapsulates in the sub-title, ‘Illness, Medicine, and What Matters in the End.’

Dr Gawande explains, “This is a book about the modern experience of mortality – about what it’s like to be creatures who age and die, how medicine has changed the experience and how it hasn’t, where our ideas about how to deal with our finitude have got the reality wrong.”

The backdrop is that, “no single disease leads to the end; the culprit is just the accumulated crumbling of one’s bodily systems while medicine carries out its maintenance measures and patch jobs… The curve of life becomes a long, slow fade.”

He describes this process as One Damn Thing After Another, the ‘ODTAA syndrome’ wherein the “pauses between crises can vary. But after a certain point, the direction of travel becomes clear.”

Johanna van den Berg, with ‘Snowy’, husband Gerry, son Raymond and senior nurse Kelly Northeast.

The eagles weren’t soaring when I visited Wedgetail Retreat nestled above the Dulguigan valley beyond Murwillumbah, although the kookaburras, butcher-birds and magpies made up for their absence.

Enhancing the idyllic scene were the distant cloud-capped mountains, a sweep of glistening canefields, and the tranquil gardens of the facility itself, fringed by remnant rainforest trees.

While resembling a North Coast pamper-resort, the facility caters not to ‘health junkies’ but to people (adults and children) with truly life-limiting illness. This is a hospice where the terminally ill, after suitable medical assessment, can spend their end days, or enable respite for their carers, in the most delightful of settings.

Residents may be accompanied or visited by family members, even a companion pet, with the added assurance of nursing supervision. An on-call physician based in Pottsville is also part of the clinical team.

High-profile federal MP Andrew Wilkie is advocating more support for allied health providers, saying their greater involvement in patient care helps free up hospital beds, speeds patient recovery and saves on health expenditure.

Mr Wilkie, the independent member for the Tasmanian seat of Denison, has long been an active participant in the health debate in his own state, and nationally.

He is co-chair of the parliamentary rural and remote allied health group.

His comments came at the launch of two reports conducted for Services for Australian Rural and Remote Allied Health (SARRAH) as part of an ANU research project.

Dr Karen Hitchcock

Book Review by Robin Osborne

Dear Life: On Caring for the Elderly; Quarterly Essay 57 / April 2015 by Karen Hitchcock

This 78-page essay by hospital staff physician Karen Hitchcock is a timely contribution to the end-of-life discussion that is attracting ever more attention from the medical and nursing professions, patients, families and advocates.

Still largely missing from this debate are the voices of our politicians – many of whom would have elderly and/or ailing family members – whose leadership is vital to the better planning, and funding, of how society supports the waning days of our lives.

The reverse applies at present, as Dr Hitchcock notes: “There are many ways to show that we devalue our elderly, are repulsed by them, terrified of becoming them, ”she writes early in her powerful and pointed analysis.