Macclesfield Express - - MACCLESFIELD PEOPLE -

DR Paul Bowen, clin­i­cal chair of NHS Eastern Cheshire CCG and GP with McIlvride Med­i­cal Prac­tice, Poyn­ton IT is dif­fi­cult to write about death with­out sound­ing mor­bid or in­ap­pro­pri­ate.

How­ever, like much the health ser­vice does, it is some­thing we can get right or ter­ri­bly wrong.

We all want a peace­ful, dig­ni­fied end to our lives but what about the weeks, months and years run­ning up to that point?

A reg­u­lar con­ver­sa­tion I have with older pa­tients and their fam­i­lies is fo­cused around qual­ity of life rather than just ‘quan­tity’ of life. By that, I mean a dis­cus­sion about what pri­or­i­ties peo­ple have when they get older. It is easy to med­i­calise the age­ing process. If doc­tors look for prob­lems in an av­er­age 90-year-old, they will find them. Whether they can be treated to ex­tend life is one thing but whether it will im­prove qual­ity of life is as im­por­tant to many peo­ple.

Dis­cussing and plan­ning the fi­nal years of our life is a dif­fi­cult and dis­tress­ing thing to do. A ter­mi­nal di­ag­no­sis of­ten prompts a can­did con­ver­sa­tion about our pri­or­i­ties but many peo­ple do not have the op­por­tu­nity to con­firm their pri­or­i­ties in later life.

This in­cludes where we would want to be cared for and the im­por­tance of dig­nity, com­fort, con­ti­nu­ity or in­de­pen­dence over the ever-present risk of hos­pi­tal­i­sa­tion, in­ves­ti­ga­tions and treat­ment.

GPs work­ing in our lo­cal care homes are be­ing en­cour­aged to start these con­ver­sa­tions with pa­tients and their fam­i­lies. In­creas­ingly we dis­cuss the same is­sues with older peo­ple in their own homes.

It is en­tirely ap­pro­pri­ate for the NHS to con­tinue to treat, ad­mit, in­ves­ti­gate and man­age pa­tients to the end of their lives.

Many older peo­ple quite right­fully wish to pur­sue ev­ery treat­ment avail­able and do so in com­fort, with dig­nity and in a place they wish to be.

How­ever, it will take a cul­tural change for us all to re­alise that ‘a good death’ starts with an hon­est dis­cus­sion about our pri­or­i­ties, whether it’s our length or qual­ity of life, care in our home or our hospi­tal, sur­rounded by loved ones or care staff. It would be in­ap­pro­pri­ate and ageist for NHS staff NOT to ex­plore these is­sues at an ap­pro­pri­ate time in our lives.

Visit the Cheshire Liv­ing Well Dy­ing Well Part­ner­ship at http://eolp.­dex.php for ex­cel­lent ad­vice and re­sources on liv­ing well, age­ing well, griev­ing well and dy­ing well.

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