Dr Kanika Chandra, Consultant-Palliative Medicine, Sir Ganga Ram Hospital explains why palliative medicine is important
The word palliative is derived from the latin word Pallium which mean a cloak/to cover something and hence palliative medicine is about relieving symptoms rather than curing the disease. Though inadvertently doctors have always practiced palliation in their treatments this branch of medical sciences is now becoming more and more significant. As per recent data by WHO about 40 million people are in need of palliative care services and among these the majority belong to low and middle income countries. Prompt attention from palliative medicine reduces unnecessary hospitalisation.
Why is palliative medicine important?
Cancer is booming, so are the lifestyle health issues , a host of debilitating diseases (like rheumatoid arthritis, cardiomyopathies, advanced osteoarthritis, pancreatitis), people living with HIV/AIDS, in children with life threathening /genetic illnesses and geriatric issues. Once something becomes labeled as incurable or the treatment becomes futile what comforts or how to ease the suffering of a patient becomes a priority. So this is where Palliative medicine fits in. It aims at bringing relief to the sufferer which in some cases is both the patient as well as the family. This accords relief in the terms of pain, emotional healing/ support, physiotherapy, easing other bothersome symptoms like chronic cough, constipation, urinary incontinence, bedsores ,poor appetite etc. It also helps face various challenges pertaining to psychological, social and spiritual aspects. Another salient and integral part of this branch is the “end of life care” which in layterms would mean moving towards death pain free and with dignity(the least that can be done without euthanasia being legalised).
On the sidelines palliative medicine within the ethical and medical framework helps the families decide judiciously about consenting for ‘Donot resuscitate’ and ‘Donot intubate’ wherever it is deemed appropriate and in the larger favour of the patient. Many a times the families find themselves devoid of the knowledge that they can take these decisions to help cut the agony of their patient by understanding the reason of a DNR or DNI in their case.
Why palliative care is different in India?
For years India has been all about large joint and emotionally attached families ,but over the last decade the society the social milieu is changing. The families are becoming more nuclear and the emotional attachments are becoming less though it cannot be generalised. There is advancement in the field of medicine and as a result we now have longer life expectancy but then at times the quality of life is not maintained and age related health issues crop up.
Caregiving itself becomes a big issue in families as the brunt of financial, emotional and physical burden is borne by one usually and it further leads to caregiver burnout and other mental health concerns(sometimes for both the patient and carer). At certain times if a elderly patient is hospitalised the primary caregiver (spouse/son/daughter) has to make decisions pertaining to the treatment of the patient with the other family members, it becomes difficult with different viewpoints and with the intervention of palliative medicine doctors a logical approach with unanimous decision in favour of all can be made.
Homecare is also a very important and indispensible aspect of palliative medicine wherein it allays unnecessary hospitalisation and hence reduces the financial burden of families while also keeping nosocomial infection (hospital acquired) risk at the bay.
palliative medicine as a branch has long been practiced in western countries and it has been well recognised under the human rights to health.
A very crucial point of this practice is about stocking, dispensing, prescribing opioids (like morphine) for distressing symptoms like pain and breathlessness. One has to be careful lest this drug is abused as opioids can be addictive and drug menance is a big issue in our country .
What are the barriers for palliative medicine?
The barriers that we have been facing in palliative medicine so far are:
- We donot have any mention on palliative care or palliative medicine in our national health policy.
- The access to opioids is difficult and strict regulation is in place for the same, there are misconceptions regarding narcotics in general public and certain reservations in medical fraternity for the same.
- Formal training in Palliative medicine is scarce and its existence is meagre when compared to our mammoth healthcare infrastructure.
- General unawareness in public about when ,where and how does palliative medicine fit in.
- Certain deep seated cultural beliefs,religious thoughts,superstitions come in the way of death and dying.
- Misconception at times that palliative medicine is only for the cancer afflicted people and for those on their deathbed.
How can palliative medicine move ahead?
Baby steps have been long taken in our country with regard to this speciality but a strong infrastructure and equally strong belief system is required for it to flourish.
- National health policy should include Palliative Medicine as a people centric and health integrated part of medical speciality.
- Expanding and reinforcing human resources in this field by providing specific training to the health care professionals and also starting Palliative care centric curriculum in the medical graduate/post graduate courses of all specialities. Equal importance may be given to it in nursing courses .
- Though empathy and compassion is integral to our health profession we need to reinforce practicing them more.
- Medicine policies be made such that pain reliever drugs and specifically opioid drugs can be stocked, prescribed and dispensed efficiently and with less hassles for hospitals in general.