Q. Laura your career started in communications and now you are a GP (General Practitioner) with an interest in paediatric palliative care – what motivated that big career change and how did you go about it?
A. When I think back on it, as a teenager contemplating my career options, I really had no idea what I wanted to do! All I knew was that I loved working with people, and I was drawn to creating fulfilling communication experiences with others. The logical step as a 17-year-old was to pursue a career in communications, but I ended up in roles that were far more corporate than I had expected. I went back to the drawing board and started to contemplate a career in medicine. It seemed to me that medicine was about people just as much as it is about science, and I felt that there was no better environment to follow my love of authentic human connection. It took me a while to get here, but I absolutely love my job as a GP. My job is all about communication, whether it be with patients or colleagues, and whether the nature of that contact is joyous or challenging. I feel so privileged to be able to experience life’s highs and lows alongside my patients.
Q.Tell me about your experience as a GP, and some of the most memorable/impactful moments have been?
A. My job is incredibly fulfilling. It can also be very challenging, but that’s part of what keeps me engaged. It is never boring and can be quite unpredictable. One of the things that I love most is how interesting, funny, quirky, resilient and surprising people can be! There have been some very memorable moments throughout my career to date. Some of those moments have been hugely rewarding, and others utterly devastating. I think the most impactful moments day-to-day revolve around the depth of connection that can form with your patients. For instance, I look after generations of families. I watch people go through life’s milestones and see children growing up and becoming who they are. The really special moments are little things, like helping a young child have a positive medical encounter which hopefully helps them to feel more trustful of the medical profession longer term. There is nothing more satisfying than having somebody (adult or child) say at the end of a consultation “I was really nervous about this, but I feel so much better now”!
Q. How important is it that we each have a relationship with our GP when it comes to our long-term health and wellbeing?
A. This is honestly my ethos as a GP. Sadly, the nature of General Practice is changing due to financial pressures and poor government funding. This means that by necessity a lot of GPs have had to adopt a higher turnover model of care. I am so lucky that as a business owner, I have more control over how my practice operates, and we have made an intentional decision to focus on slower medicine. This means that I can take the time to really get to know my patients. When you assess a patient, and you measure their “vital signs” (such as blood pressure, heart rate and temperature), you can objectively measure how unwell they might be. As a GP, I feel like I have access to an extra ‘vital sign’ and that is the “I can just tell – you don’t look like yourself” sign. When I know my patients well, I know just by looking at them that something is not right. This also means that I am able to advocate more strongly for my patients, because you can appreciate even subtle deviations from their normal baseline.
Q. GPs often care for and support people for a long time – providing advice, care and restoring health. How does palliative care fit in the GPs role?
A. Palliative care is an essential part of General Practice. When it comes to my patients, I am there to support them throughout life’s journey. Some of these encounters will be around acute, self-limiting illness. Many are focused on life transitions, such as births, menopause, ageing or death and dying. I see death and dying as a normal life transition. Of course, this doesn’t mean that it is easy or comfortable, but helping my patients to feel supported and be able to have open discussions about dying and death is fundamental.
Q. What has been your experience with paediatric palliative care?
A. I think most GPs would be limited in their palliative care experience within a paediatric population. This is largely because we live in a country with very good health outcomes and average life expectancy. I feel very privileged to have some limited experience in the field of paediatric palliative care but would not claim to be an expert by any means. My role as a GP within this highly specialised area is to be the consistent point of contact for my patient and their family. I often feel like my role is analogous to a conductor, in the sense that there may be many different treating teams involved, but my job often requires facilitating and coordinating input from others to help create a cohesive plan for my patient.
Q. Referring a patient to paediatric palliative care can be challenging. How do you manage this? What is it that only experience can teach you?
A. This can be incredibly challenging, and I think it’s absolutely fine to acknowledge that. I am a doctor, but I am also a person, which means that I often feel quite personally challenged by delivering bad news to my patients. I find it really helps to have frank and open discussions with my patients. For me, a referral to paediatric palliative care is all about having specialist input regarding my patient’s symptom management. Often people will interpret a referral to palliative care as a sign that you are “giving up on them”, but I try really hard to explain to my patients that palliative care services are about optimising quality of life for people with life-limiting illness. From experience, I have learned that it is ok to not always have an answer or a solution. Sometimes my job is to acknowledge how uncomfortable uncertainty can be, and to just sit with my patients and listen. I am so much more comfortable with the phrase “I don’t know” than I was as a junior doctor.
Q. As you say, some people can feel like a palliative care referral is “giving up on hope” or a conflict with a doctor’s Hippocratic Oath, what do you say to that?
A. I have definitely encountered this, and it can be difficult to reframe people’s thinking around palliative care. For me, palliative care is about specialised symptom control. I have palliative care patients who are highly functional and really quite well, whose input from the palliative care service at that time might be quite limited. Hope is so important for the human spirit, but I also feel that I owe my patients honesty and realism. If I am able to have frank discussion with my patient about a diagnosis and its associated prognosis, I feel better equipped to provide them with the comprehensive, multi-disciplinary care they need. Some people may be more ready than others to proactively engage with a palliative care service, which is pretty understandable. But my role is to continue to educate my patients and provide them with evidence-based information, so that they feel more able to make an informed decision about what would be best for them.
Q. What level of training or exposure to palliative care do GPs get during their study and training?
A. Death and dying is a normal part of life and therefore of General Practice. However, I feel that the exposure of most GPs to palliative care during medical and specialist GP training is likely to be limited, and therefore something that many practitioners might feel uncomfortable or ill-equipped to manage. I certainly feel that I am learning an immense amount about paediatric palliative care with my patients.
Q. Tell us about your experiences with a paediatric palliative care team?
A. I have had some lovely experiences with the paediatric palliative care team. I have found the team to be very accessible, and keen to work collaboratively. My patients have also described feeling very well supported and firmly “held” by the paediatric palliative care team.
Q. Collaboration and taking a holistic approach are key to providing quality palliative care. How have you seen that work, or not work when it comes to engaging other physicians, specialists, nurses, and other health professionals?
A. I find a collaborative and multidisciplinary approach to be such a rewarding way to practice. I have also witnessed time and time again that patient outcomes are generally better when their treating team is able to work cohesively, and towards the same specific goals. It can be frustrating as a GP when feedback and correspondence from other treating teams are not received, and I spend more time than I would care to admit “chasing” letters and results so I can get myself up to speed. The person that suffers in this situation is the patient. I am always happy to make myself available to talk to other care providers about my patient. I think one of the limiting factors at the moment is that everybody is busy and time poor, and a lot of the communication systems we rely on are quite antiquated, slow and unreliable. This no doubt opens up some exciting opportunities to refine the way we communicate and share patient information.
Q. What can the health system learn from people and families traveling an end-of-life pathway?
A. It’s important to remember that for healthcare providers, the ‘system’ is part of our normal, daily experience. For our patients, their exposure and knowledge of the system is likely to be very new, scary and overwhelming. This is the case for any medical encounter, but particularly when we are supporting patients and families at the end of life. I have witnessed many patients feel quite overcome by the business of death and dying, which likely will involve multiple referrals to different teams, often in differing locations. The referral pathways can be quite different, and many teams will offer specific programs or services which may have acronyms, or staff in roles that are not understood by the patient. Of course, I would say this, but simple and clear communication is so important!
Q. What are the challenges you face as a GP in paediatric palliative care that need to be addressed?
A. Given it is a highly specialised field that many GPs are likely to have limited experience in, it can be difficult for GPs to access collegiate support. I think GPs would likely benefit from access to further professional supports so we can feel better prepared to manage our paediatric palliative care patients independently. By this, I mean there are likely areas where further education for GPs might allow patients access to certain treatments or interventions with their primary care provider, instead of needing escalation to other teams.
Q. What would you say to other health professionals who are nervous about getting involved in paediatric palliative care?
A. It’s ok to be nervous! I get nervous about managing any clinical scenario that I haven’t had much experience in managing previously. But ultimately these patients need you, their primary care provider, to help them navigate this uncertain and perhaps unexpected path ahead.
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