Too few doctors are trained to deal with dying patients


UK – Experts from Kings College London have warned that too few doctors are trained to deal with dying patients. Doctors 

must focus on the spiritual needs of dying patients as well as their physical symptoms to make sure they have a dignified and comfortable death, health experts have said.

The National Institute for Health and Care Excellence (Nice) is currently consulting on new guidelines for end of life care, which will replace the controversial Liverpool Care Pathway.

But experts say the guidance fails to address severe problems in the way doctors deal with dying patients. Just one in five trusts say doctors should have end of life training, with most medical schools only teaching how to ‘fix people’ not how care for patients when there is nothing more do be done.

And one in five hospitals have palliative care services seven days a week, despite recommendations to do so.

Dr Jonathan Koffman and Dr Katherine Sleeman, palliative care lecturers, said the spiritual beliefs of patients were often ignored because death was still viewed as ‘taboo.’

“We’ve become very good at saving lives but not so good at dealing with death,” said Dr Sleeman

“People focus on the physical but they is not much attention paid to spiritual or psychosocial needs.

“It’s quite scary to sit down and ask the patient about death and what they are afraid of. It’s not something doctors want to do, but it is absolutely essential.”

Dr Koffman added: “We are teaching medical students most of whom who have never experienced a death, or grieving. Death has been removed from the mainstream. It’s really the last taboo.

“It’s incumbent on us to provide to make sure that end of life care is the best we can provide. We can’t undo these moments.

“Most complaints are usually focussed on the last year of life.”

Around 50 per cent of people die in hospital despite the fact most want to die at home while their families are often excluded from critical decisions and conversations about treatment.

“The reality is that they don’t get what they want,” added Dr Koffman.

The Liverpool Care Pathway, which was introduced in the late 1990s, led to controversy after some patients were deprived of food and water.

It was introduced in an attempt to ensure people had a dignified and comfortable death.

But an independent review found some patients had been left thirsty, families were uninformed and decisions were sometimes taken by inexperienced staff.

Dr Sleeman said the LCP was problematic because it focused on processes and “ticking boxes”.

When it was phased out some nurses said they did not know what to do, she said.

“That made me feel it was the right thing to do to get rid of it – it suggests they were using it far too much as a crutch,” she said.

New draft guidelines were introduced by the National Institute for Health and Care Excellence (Nice) in July.