Doctors ‘ have no idea how to look after their terminally-ill patients’
BASIC humane care for dying people has been forgotten by doctors because modern medicine is fixated with a ‘heroic war on disease’, according to two leading medical experts.
Doctors receive far too little training in dealing with dying patients – just 20 hours out of five years at medical school – and nurses often ‘do not know what to do’ with them, they claim.
Dr Katherine Sleeman, a clinical lecturer in palliative medicine at King’s College London, was speaking yesterday at a discussion in London about how to replace the controversial Liverpool Care Pathway (LCP).
The LCP’s guidelines on caring for dying patients was scrapped two years ago after the Daily Mail highlighted how families witnessed their loved ones being hastened to their deaths by being denied food and water.
An independent inquiry said it led to ‘ uncaring, rushed and ignorant’ treatment of the most vulnerable patients. The NHS watchdog NICE has now published draft guidelines on care of the dying.
But Dr Sleeman said one of the reasons she is convinced it was right to get rid of the LCP was because nurses told her ‘they did not know what to do’ to look after the dying without it.
She said: ‘I heard from nurses that it was dreadful that the LCP had gone. Nurses just didn’t know what to do.
‘That makes me feel it was right to get rid of it.
‘There should be no situation where they don’t know what to do because they haven’t got a piece of paper with them. So it suggests it was being used far too much as a crutch rather than a tool to guide palliative care.’
But Dr Sleeman said the new NICE guidelines still do not focus enough on ‘ patient outcomes’ – how patients feel about their treatment. Part of the problem is that doctors are too focused on medical interventions – which sometimes do more harm than good.
She said yesterday: ‘The trouble is these things [patient outcomes] are eclipsed by life-saving and all this heroic war on disease stuff that takes up so much of the budgets, education and training for doctors.’
It was not acceptable that only one in five trusts train doctors in care for the dying, she said, adding: ‘It strikes me that 100 per cent of doctors are going to have to care for someone who is dying; it strikes me that 100 per cent should have some mandatory training on how to look after those people. ‘There were many occasions when I went to see a patient and looked at their Liverpool Care Pathway and saw tick, tick, tick, tick, everything’s above board, and I’d open the curtains and think, “Oh. Oh dear. Yes all these boxes are ticked but this patient is in pain.” ’
Her colleague Jonathan Koffman, a senior lecturer in palliative care at King’s, added that good care for the dying could be as simple as staying with a patient and allowing them to drink a cup of tea ‘at their pace, rather than leaving a cup of tea in front of them and it being lukewarm or cold’.
He said modern doctors had many more treatments available to them than in the 19th century, but as a result they had lost the ability to look after the dying as they were too busy carrying out interventions and tests.
Asked what should replace the LCP, Dr Sleeman said that any new guidelines should ‘prompt doctors to provide the best care, rather than telling them what to do every two hours’.