Working life (palliative medicine)
This page provides useful information about the roles and responsibilities of doctors in palliative medicine, where they work, who they work with and what they feel about their role.
"Palliative medicine allows me to talk truthfully and openly about sensitive end-of-life issues with patients – something other specialties don’t often have the time or training to do well. This makes it an immensely satisfying discipline. Furthermore, it provides challenges in the medical management of complex symptom control problems and allows me the privilege of gaining insight into patients as more than medical cases. As a palliative medicine specialist, I build up an understanding of each person as a whole, and enable honest communications about end-of-life issues with patients, their families and often other healthcare professionals." - Consultant in palliative medicine
The range of work undertaken by specialists in palliative care varies according to how the local service is constructed. This is affected by the role of the voluntary sector (eg in the funding of posts), hospital and community facilities, the extent of integrated care arrangements and the decisions of commissioning groups.
More than with other specialties, consultants in palliative care often find that they have clinical leadership and managerial roles early on in their careers and often become involved in the strategic development of local services.
Doctors in palliative care also undertake a range of non- clinical activities known as supporting professional activities. As with any doctor this would be expected to include personal development (CPD), audit and quality improvement, education and research. However, for palliative medicine, education is often a large commitment.
There are academic posts in palliative medicine; however many doctors focus energies on clinical services and teaching more than research but this is changing. Increasingly there are research opportunities in any setting through collaborative projects.
How your time is spent
Full-time consultants are normally contracted to work 10 programmed activities (PAs) including 1-2.5 supporting professional activities (SPAs) per week. SPA quota may vary according to the employing organisation although 2.5 is recommended by the College of Physicians. A PA relates to portions of four hours.
Typically, they spend about two-thirds of their time on clinical work comprising both direct bedside assessments in hospital or home, ward rounds, outpatient care indirect patient care (case discussion with other professionals including telephone advice) and the documentation/communication relating to these.
They would also attend at least one formal multidisciplinary team meeting (MDT) each week.
On-call and working hours
Working hours are usually 8.30am to 5pm but can be longer if there is a need to communicate with family members who can only visit patients at the end of the working day. On-call requirements vary – some placements may have no on call, while others may require specialists to be on call around 20 per cent of the time. Over 65% of consultants say they are routinely on-call at weekends. This may entail hands on clinical responsibilities for inpatients in a hospice, or as part of a shared rota to provide advice and support to other teams in hospital and community settings. Generally, the specialty lends itself to a good work-life balance.
Less than full-time working is common in this specialty with over a half of women consultants and three-quarters of SAS doctors doing so. Less than full-time consultants are likely to spend little of their time doing research.
Doctors in palliative care work in multidisciplinary teams. The specialist palliative care team usually comprises:
- palliative care (clinical) nurse specialists (CNSs
- professionals from psychological support services
- allied health professionals
- specialist pain teams
A hospice is often established in the independent sector, partly funded by NHS. Here there will be a mix of staff including input from GPs with a special interest in palliative care and an important contribution is often made by lay people such as volunteers.
Specialist palliative care teams in turn work closely with the primary care or hospital team involved with an individual particular patient. There are close links with other specialities such as oncology, chest, cardiac and renal medicine.
Building relationships with patients and their families is enjoyable – even if only over a short period of time. It is also intellectually and emotionally satisfying to understand their medical, psychological, social and spiritual needs.
Palliative medicine is highly person-centred. There is considerable satisfaction derived from enabling a patient to make sense of what has been happening, providing support and enabling them to make important choices and feel more in control again. Making a difference to patients’ lives and being the recipient of their trust and open, honest communication is also very rewarding.
Working in a multi-professional environment is also an attractive aspect of the role.
The challenge comes from having to acknowledge that some clinical symptoms may be intractable and some family problems insoluble. This specialty deals with people who have a limited prognosis and clinicians in this field need to manage sensitive communications around death and dying issues. It is important to maintain the right balance between meeting the needs of patients and families and your own needs, whilst avoiding emotional burn-out in the long term.