I have been thinking through how my work with dying patients should interface with my personal faith and belief. I come from a conservative evangelical background, and therefore my church friends have made comments like,"It must be hard to look after patients who you know are going to go to hell in a few days' time." Well, I don't really look upon my patients that way, but I suppose it could be true. On the other hand, the workplace is quite secular, and "spiritual care" is provided in a very broad sense and focused on what it means for each individual. The chapel has recently been refurbished to become a very neutral "pilgrim room", with no religious symbols except for candles. And the "spiritual care lead" (previous known as chaplain) was very happy with the result.
Deep down inside, I feel that the longer I stay in palliative medicine, my theology will probably become more liberal so as to allow my faith to sit comfortably with my work. Which apparently is the route that Dame Cicely Saunders, the great founder of the modern hospice movement took. But part of me thinks whether that will be a bad thing and a sign of me "drifting away" from my faith. After all, our faith is not meant to sit comfortably in the realm of the secular world is it? So perhaps I need to "hold fast my confession" and accept that it will always clash with the worldly values.
Anyone has any thoughts or comments or recommendations of books or resources I could read?
Thursday, 19 March 2009
Monday, 2 March 2009
Further thoughts on "Palliative Medicine" by Declan Walsh
Okay, so I am working through the "drugs" section of the book, and I reach Chapter 122, which is Neuropharmacolgogy and Psychopharmacology. This begins with Antipsychotics, which is quite a concise overview of this category of drugs - helpful. Then it goes on to antidepressants... but this bit is not so readable. It throws a few really biochemical sentences and pictures with hardly any context, and I don't come away with the sense of having learnt anything useful.
I am now hungry for some information about anti-depressants. So although I intended to work through the sections of the book in the order that they are presented, I skip to the symptoms section... Chapter 157 - Depression. Which is another readable concise chapter, which briefly touches on therapeutics in a single 10-line paragraph. This refers me to Figure 157-3, and I look for this figure with great hope that it will summarise therapeutic treatment of depression for me... I can't really find it... and then I discover it... not what I was expecting really... it was a picture of some pills, with a caption which reads "When planning the pharmacological management of depression, providers should consider medications' effectiveness, tolerability and safety profile to minimize side effects and avoid drug interactions." Now as a "provider", this is precisely what I would like to do, but it seems like this humungous 1475-page reference book on palliative medicine is not giving me the information I require to make those considerations.
I look back to the contents page again, to try to figure out just how the chapters are organised... and then I chance upon a Chapter 130 which is on Antidepressants and psychostimulants! I turn to this chapter, and finally I find some useful information about the various anti-depressants.
Okay, so I look back at the contents page again... to see if I have missed out any other chapters on depression and anti-depressants. I haven't found any more for now, but I won't be surprised if I came back to this book next week and found another one that I missed today.
Now, these three separate chapters on depression and anti-depressants are written by totally different people from three totally different places - Ohio, Ireland and Canada. One would have thought that they should co-ordinate the chapters that are on similar topics. And none of these chapters actually pointed you to the other relevant chapters with overlapping material.
Then a thought occurs to me - I did say in my last post that the plus-point of this book was that it came with online access with a search function. So I went online to search for "depression", and the results were disappointing. The first 10 results point me only to chapter 157 but not to the other two chapters. Then I spot a line on the top that says "Do you mean depressive disorder?" Aha! That must be it, if I search for "depressive disorder" instead, that would do the trick... alas, even that did not point me to either of the other two chapters. So as a result, I have to take back what I said in the previous post about using the online access to find all the chapters which are relevant to the topic you want to read up on. Disappointing... there was so much promise...
Anyway, here's what I think so far: The book has too many authors - a staggering 403 authors from 23 countries. I know it's a big reference book, but even so, with 403 authors, it does make the book a bit bitty.
I am now hungry for some information about anti-depressants. So although I intended to work through the sections of the book in the order that they are presented, I skip to the symptoms section... Chapter 157 - Depression. Which is another readable concise chapter, which briefly touches on therapeutics in a single 10-line paragraph. This refers me to Figure 157-3, and I look for this figure with great hope that it will summarise therapeutic treatment of depression for me... I can't really find it... and then I discover it... not what I was expecting really... it was a picture of some pills, with a caption which reads "When planning the pharmacological management of depression, providers should consider medications' effectiveness, tolerability and safety profile to minimize side effects and avoid drug interactions." Now as a "provider", this is precisely what I would like to do, but it seems like this humungous 1475-page reference book on palliative medicine is not giving me the information I require to make those considerations.
I look back to the contents page again, to try to figure out just how the chapters are organised... and then I chance upon a Chapter 130 which is on Antidepressants and psychostimulants! I turn to this chapter, and finally I find some useful information about the various anti-depressants.
Okay, so I look back at the contents page again... to see if I have missed out any other chapters on depression and anti-depressants. I haven't found any more for now, but I won't be surprised if I came back to this book next week and found another one that I missed today.
Now, these three separate chapters on depression and anti-depressants are written by totally different people from three totally different places - Ohio, Ireland and Canada. One would have thought that they should co-ordinate the chapters that are on similar topics. And none of these chapters actually pointed you to the other relevant chapters with overlapping material.
Then a thought occurs to me - I did say in my last post that the plus-point of this book was that it came with online access with a search function. So I went online to search for "depression", and the results were disappointing. The first 10 results point me only to chapter 157 but not to the other two chapters. Then I spot a line on the top that says "Do you mean depressive disorder?" Aha! That must be it, if I search for "depressive disorder" instead, that would do the trick... alas, even that did not point me to either of the other two chapters. So as a result, I have to take back what I said in the previous post about using the online access to find all the chapters which are relevant to the topic you want to read up on. Disappointing... there was so much promise...
Anyway, here's what I think so far: The book has too many authors - a staggering 403 authors from 23 countries. I know it's a big reference book, but even so, with 403 authors, it does make the book a bit bitty.
The book I am reading now
So far, I have found it quite readable, with short chapters so that you can get through 2-3 chapters in one sitting easily. The downside is that the chapters are organised in such a way that you have to jump from one section to another if you want to read around a particular topic. For example, I was just reading about nausea and vomiting... which is dealt with in chapter 144 which is in the "drugs" section as well as chapter 169 which is in the "symptom control" section.
Having said that, the book also comes with online access to the book, which means you can enter a search term and get a list of results: usually a few short chapters that are most relevant to the keyword.
First impressions: great as a reference. Not sure if it can be read cover to cover.
Sunday, 1 March 2009
How I got interested in Palliative Medicine
Palliative medicine was actually first suggested to me by a friend while we were medical students. He had his day in Arthur Rank Hospice as part of the rotation through various specialties and he rang me on the phone to say "Grace, I have found the specialty for you." He clearly thought I was well-suited for it. And he was right, when I had my day in Arthur Rank Hospice, I was really drawn to the specialty... What particularly drew me was the focus on the patient as a person with both physical and non-physical needs, rather than just a physical body, and also the high consideration given to quality of life.
To explore this interest further, I spent part of my elective doing palliative medicine in Singapore. Through this, I realised that a good palliative medicine physician had to have a strong foundation of general medical knowledge due to the range of problems that present to palliative care. I also appreciated the importance of good history-taking and clinical examination skills in assessing a patient. This was a relief to me as I was worried that my medical knowledge and skills will be laid aside if I went into this specialty. I worked alongside palliative care doctors who were both passionate about and excellent at what they did. Dr Cynthia Goh and Dr Noreen Chan deserve particular mention at this point, as they were the consultants I worked with during my elective.
After graduation from medical school, I worked in a series of medical and surgical jobs. Throughout this time, I took a special interest in patients who were terminally ill and had been, as it were, left to die as nothing more could be done for them. I enjoyed liaising with other members of the multi-professional team and gained great satisfaction from being able to improve the quality of life of these patients who had a limited prognosis.
I wanted to experience how palliative medicine was like on the ground before committing to training in the specialty, so I organised a period of “out-of-programme experience” in St Christopher’s Hospice, which I have thoroughly enjoyed... more about St Christopher's another day.
Anyways, so here I am, working in St Christopher's Hospice. And I've got a place in the palliative medicine training programme in the Eastern Deanery, which starts in August 2009... which I am really looking forward to.
I am starting this blog as I hope to share my experiences as a trainee in palliative medicine.
To explore this interest further, I spent part of my elective doing palliative medicine in Singapore. Through this, I realised that a good palliative medicine physician had to have a strong foundation of general medical knowledge due to the range of problems that present to palliative care. I also appreciated the importance of good history-taking and clinical examination skills in assessing a patient. This was a relief to me as I was worried that my medical knowledge and skills will be laid aside if I went into this specialty. I worked alongside palliative care doctors who were both passionate about and excellent at what they did. Dr Cynthia Goh and Dr Noreen Chan deserve particular mention at this point, as they were the consultants I worked with during my elective.
After graduation from medical school, I worked in a series of medical and surgical jobs. Throughout this time, I took a special interest in patients who were terminally ill and had been, as it were, left to die as nothing more could be done for them. I enjoyed liaising with other members of the multi-professional team and gained great satisfaction from being able to improve the quality of life of these patients who had a limited prognosis.
I wanted to experience how palliative medicine was like on the ground before committing to training in the specialty, so I organised a period of “out-of-programme experience” in St Christopher’s Hospice, which I have thoroughly enjoyed... more about St Christopher's another day.
Anyways, so here I am, working in St Christopher's Hospice. And I've got a place in the palliative medicine training programme in the Eastern Deanery, which starts in August 2009... which I am really looking forward to.
I am starting this blog as I hope to share my experiences as a trainee in palliative medicine.
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