This article was written for medicinemalaysia.com on 9th February 2014 in conjunction to World Cancer Day. It is the first part of three.
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Palliative medicine is a relatively new field in Malaysia. It is, at the moment, growing, as more people joined its training programme. Exposure to palliative medicine has also widened as doctors from Masters of Medicine as well as pain management trainees under anaesthesiology are introduced to at least a few weeks of their training programme.
The field, however, needs more understanding amongst medical practitioners. Despite a few weeks to months of exposure, many still do not comprehend the essence of palliative medicine. This enlightening field is commonly perceived as “frustrating”, “do nothing, no active resuscitation”, and “easy, just give morphine”. Having worked in a specialised palliative care unit for more than three years have proven those perceptions wrong.
Cancer itself is regarded by many as a taboo, by both doctors and lay person. It is disliked by many doctors as it marks as a failure of modern medicine; although many are curable, patients present late, it tends to recur, and when advanced, it’s incurable, hence the “death sentence” stigma that’s stuck with it. With lack of understanding on palliative care, many doctors tend to think that there is “nothing to do” once a patient has advanced cancer, and worse when they are terminally ill.
As with other fields of medicine, there are many aspects that need to be approached in palliative care, even at the end of life, as well as after death. The natural history of advanced cancer renders the patient to disease progression, deteriorating performance status leading to increased dependency, and worsening symptoms.
With the aim of improving quality of life, the outcome is that the remaining time the patients have is used to its fullest. That, in itself, gives much enlightenment, gratification and job satisfaction to both the caregivers and medical practitioners.