A BIT OF CARE

WILL BE NICE
Dato’ Seri Dr T Devaraj
CEO / Medical Director
NCSM Penang Branch

8th Malaysian Hospice Congress

13 – 15 June 2008
Penang, Malaysia

There is no cure……
There’s not a lot that
medicine can do

PATIENT

DOCTOR

Just a bit of care

would be
nice……

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 Dame C Saunders
1918 - 2005

HOSPICE CONCEPT
z Whole person care addressing all the problems
even though disease is advanced
{will reduce suffering
{die with dignity

z Support family

“requirements were compassion and modern

medicine”

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 WHAT WHO SAYS ABOUT PC

z 1990 - is the active total care of patients whose disease is not

responsive to curative treatment

z 2002 - is an approach that improves the quality of life of patients

and their families facing the problem associated with life threatening
illness…

z 2002 - is the active total care of the child’s body, mind and spirit,
and also involves giving support to the family

it begins when illness is diagnosed, and continues

regardless whether or not a child receives treatment directed at the
disease…………….

CRITERIA FOR P C

z Terminally ill or not responsive to curative Rx

z Message - “Only those who are going to die
have problems that require whole person care”
z Reinforces negative view of hospice
z Implies survivors do not need care
z Marginalises caring in mainstream medicine

Think point : at any one time there will be more

patients ill (many with problems) than those ill
and dying

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 P C – WHY, WHEN ?

Saunders
Death
suffering T ilI

WHO 1990 Death

Not responsive
to curative Rx
WHO 2002 Death
Quality of life
in LTI

PALLIATIVE CARE AND SUFFERING

z P C focus - reducing suffering at end of life

care

/……………………………………………………/
problems death

Think point:
Problems can be present from diagnosis.
Should not these problems be addressed?

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 EXPERIENCE OF PC

PT and FAMILY
ask
why such care was not
provided earlier

QQQQQQQQQQQQQQQ

IS HOSPICE CARE SYNONYMOUS

WITH END OF LIFE CARE?

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A BIT OF CARE WILL BE NICE/MHC/JUNE2008 6
 CORE CONCEPT

“holistic care that addresses all problems”

Note: picture deleted

KEY ISSUES

holistic care - for whom ?

when ?
who responsibile?

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 DISEASES

Minor
Major – acute or chronic
+/- life threatening

PATIENT’S EXPECTATIONS

Get well (cure)

Feel better (control)
Care and Comfort

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 MAJOR DISEASE - OUTCOMES

CURE CONTROL DEATH

WHOLE PERSON CARE FOR ALL

“caring and curing inseparable”

WHEN CARE NEEDED ?

Cure
Control

MAJOR Death
DISEASE
z Patient centered care
z Care involves all health professionals
z Problems addressed appropriately from
diagnosis
z Will minimise suffering regardless of disease
outcome
z Expected and acceptable by all stakeholders

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 FOCUS OF CLINICAL CARE

CURE CONTROL

CARE

THE EVOLUTION OF THE HOSPICES

“In many ways I think this is the most exciting way

forward, helping to move support and symptom
control to an earlier stage of the disease. It
emphasizes that hospice treatment is not merely a
last resort but can be practiced in the general and
teaching hospital”
“It is only when such care is spread through the
National Health Service in general, in both hospitals
and the community, as well as in hospices, that
these people will have the help they need”
Dame Cicely Saunders
Parthenon Publishing Group 1988 & Free Inquiry 1991/92 Vol 12 No.1

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 WHAT IS PALLIATIVE CARE?
z Palliative care is basically just good medical care, and it
can be delivered by any care provider who has the
approach and skills in an environment of support
z All specialists, family doctors and nurses should accept
responsibility for the delivery of good care, relying on
specialized palliative care staff and programmes only for
the most difficult or unusual problems

Ian Maddocks
Emeritus Professor of P C

PALLIATIVE MEDICINE AS SPECIALITY

z Palliative care developing as a medical

speciality since 1987
z +ve : better care, professional education,
training, research, increased awareness of
public and government of need for good care
z -ve
{caring as specialist function
{need unique person, skills, time
{dangers of vertical development of caring

“caring is integral to good medical practice”

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 GOOD MEDICAL PRACTICE

z Cure or control of disease

z Good symptom control
z Good communication
z Skilled nursing care
z Involve patient and family
z Address emotional ,social, spiritual issues
z Emphasise quality of life
z Team work

“competent and compassionate care”

THE CHALLENGE

re-establish
whole person care
as good medical practice
involving all clinicians

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 MESSAGE FOR ALL CLINICIANS

“you can start

tomorrow”

Dr Mary Baines
National Palliative Care
Conference, November 1993

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