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Ensuring quality of life for end of life patients

Dr Joe Kosterich discusses the increasing pressure to deliver end of life care outside hospitals and the important role GPs play in ensuring the best quality of life for their palliative care patients.

''I would like to die in hospital with lots of tubes inserted into me, surrounded by staff but no family'' , said no one ever! We would all like to be surrounded by loved ones and in our own home at time of passing. At the same time we want to be as comfortable as possible.

  With an ageing population there is increasing pressure to deliver end of life care outside hospitals. Palliative care has typically been thought about in regards to those with cancer, but is also applicable to others at the end of their time on earth.

It is about allowing the person to have the best quality of life they can have in their circumstances. It is more than “medical care”, it is literally, whole of person care.

  It came home to me recently whilst visiting a patient at home (who was not expected to make it out of hospital) how much difference being in your own home makes. People have more autonomy, they tend to sleep better, they can eat foods of their choice and can interact better with those around them. At any level of capacity, it is empowering to the patient.

  Necessarily there are a variety of supports that need to be in place. These are both for the individual and also for their carers. The GP is an important part of the team. For some GPs this can seem daunting and beyond their remit. This is not the case.

 The family GP is best placed to do the medical management and to call in and draw on specialist support where needed. In some respects this type of care is not the “high tech heroics” that one might see on TV but the steady hand of knowledge that comes from knowing the person and the family.

 Of course there are a myriad of other services to consider including cleaning, gardening, delivery and preparation of meals and respite care. Planning ahead is also part of the process. This is another role where the GP can be of enormous value.

  Often as GPs we think that somehow we need to do everything. Increasingly the future is the GP as part of a team. The team involved in palliative care in the home is a considerable one. It may also change over time and be necessarily different for different people.

  In these days of specialisation, the need to see the big picture is often forgotten. The GP is the member of the medical fraternity who deals with the person rather than one organ or a certain condition. The GP is also the medical person who (generally) knows the family and circumstances of the individual.

  This is of huge importance in palliative care and end of life care. It is about allowing the person to have the best quality of life they can have in their circumstances. It is more than “medical care”, it is literally, whole of person care.

  Caring for the person whatever their situation is a primary role of the GP.


Jow KosterichDr Joe Kosterich MBBS
Doctor, speaker, author of three books, media presenter and health industry consultant, Dr Joe Kosterich wants you to be healthy and get the most out of life.He is a regular on Channel 9 and radio, writes for various medical and mainstream publications, as well as maintaining a website and blog providing health information. He is the health ambassador for locally grown fresh potatoes. Dr Joe also gives practical motivational health talks for the general public and organizations.