A GP's Story
Frontline GPs who deliver palliative care in NSW are doing it tough, primarily because they don’t have the time, lack specialist training and often scramble themselves to gain the support they need to offer care to the dying and their loved ones.
For one Sydney metropolitan GP who takes on palliative care patients and does home visits on top of her hectic daily practice consults, the frustration is clear: she is one of few doctors to deliver palliative care. She does not have a formal specialist palliative care qualification but uses skills she gained from a stint in aged care as a trainee.
“I am not a physician of palliative care. I’m a GP. I know a little bit about a lot of things but not a lot of detail. There will be a certain point where I go: ‘Right, that’s reached the end of my knowledge. I need help’. And the key is knowing when to ask for help,” says the GP, who wishes to remain nameless.
The trouble is, the help is often not there because of a lack of specialist doctors and nurses and an uncoordinated team approach.
“There are not enough Clinical Nurse Consultants and accessible palliative care doctors. That would be helpful and that is where the gaps are,” says the GP.
“It’s all very well that I prescribe medication but I don’t bring it. So accessing that medication is really difficult for patients and I don’t know what some of the nurse consultants do, but if you are affiliated with the hospital then the pharmacy at the hospital dispenses the medication and it can be brought out by the nurse.”
Family members are often left holding a script after a home doctor visit and are forced to leave the patient and find “ridiculously high doses of medication from a pharmacy somewhere”.
“I think that’s really difficult,” says the GP.
Delivering palliative care is often not possible, unless the local GP spends her down time working at night after a full day seeing patients and keeping on top of essential paperwork.
“There are only so many palliative care patients that any doctor can see at one time, a) because of costs and b) because your patient times are booked up,” says the GP.
“If I come to work and there is only a 15-minute break all day, that is not enough time to see a palliative care patient, unless they come in to see me, and it is very rare that would be the case.
“So it’s, when do you see them? It’s 8 o’clock or 9 o’clock at night which is not necessarily appropriate for the patient, let alone your own personal lifestyle. But we all have patients where you will do that: they are very sick and so you will go at 8 o’clock at night a couple of times a week until they pass away. But you can only really do that one patient at a time otherwise there are not enough hours in the day and it’s just not sustainable.”
When our loved ones are diagnosed with a terminal illness they deserve the best possible care and support. But, right now, that’s not always possible because there's a shortage of specialist palliative care in NSW. That’s just not good enough. We need the NSW Government to fund an additional 139 doctors and nurses and to meet the palliative care needs of Aboriginal communities.