Haematologists do have this reputation and I suspect me discussing it will upset some 👇
Haematology is an amazing specialty and we are lucky enough to follow patients through every step - the biopsy, the pathology, the treatment and the follow up. We really get to know them
Many haematological illnesses have amazing cure rates, response rates and available options, even in relapse - we can bring lots of hope to desperate situations.
But at some point with many of our patients those options dry up. Recognising that point is very difficult for both the haematologist and the patient. Both will have worked together for years fixing things.
Recognising the moment can be easier for those outside of this relationship - the ITU doctor, the patient’s family, the admitting medic for example. It is not fair or right that these doctors then have to discuss end of life care.
Some patients at this point may never thought about dying, have made no plans, do not have their affairs in order and have not talked with their family about what is important to them.
Failing to do that is something we, as the treating doctors, have to take responsibility for. We have a duty to recognise when treatment is unlikely to help.
We have to stop holding onto possibility and instead talk about realistic probability of success and realistic practical discussions of what treatment really means
It is absolutely OK to do nothing sometimes. The number of looks of relief I have seen over the years when I say that amazes me. Patients think THEY are letting ME down when we stop. Nope.
So the hard bits - recognising when treatment is futile and talking about end of life care. My advice...
Involve palliative care services with as many patients and as early as you can. You know who needs this chat. Make it your routine.
If you find it difficult talking about death, find someone who can, watch them, learn the techniques. It will happen to us all and I bloody well want to know when I am in my last year so I can do what I want when I want.
Listen for your alarm bells - the nurses saying “are you sure”, the phrases “fourth line treatment” and “early relapse” for instance.
A tip for spotting the last six months appeared on Twitter and I can not remember who it was , but it is recognising the appearance of the four horseman of the apocalypse:
1. An incurable cancer
2. Immobility
3. Weight loss
4. Admissions to acute care
If you see two or more horsemen make sure you involve palliative care.
2. Immobility
3. Weight loss
4. Admissions to acute care
If you see two or more horsemen make sure you involve palliative care.
