Conversation with Olaf Lubas, physician, head of the Palliative Medicine Unit at the Camillian Centre for Palliative Medicine in Tarnowskie Góry on palliative care, the humanisation of medicine and experiences from the pandemic.
Medexpress: Humanising medicine - what should we associate the term with?
Olaf Lubas: The vast amount of literature that exists on the subject makes it difficult to come up with a clear definition. Undoubtedly, the common point in all definitions is that the focus is on our patient and their loved ones. Medical personnel direct their attention to ensuring that the patient's care is respectful of his or her individual needs, dignity, autonomy and that medical procedures are as uncomfortable as possible for the patient. Humanism puts the patient's well-being first, where it is not just about eliminating physical ailments. Unfortunately, the doctor is often not interested in other aspects of the patient's wellbeing, and these can be very important, either hindering or facilitating the therapeutic process. Patients have their own character traits, beliefs, agree or disagree with something, have spiritual, social and psychological problems. In palliative care, we see this every day, especially with the patient at home, when we enter their privacy and their life. It is necessary to recognise all these characteristics of the person in time, so it is good if the care starts early, which allows us to get to know the patient better and accept certain nuances. It has been an accepted pattern in our community for years that a team is delegated for home visits and in-patient care: doctor, nurse, rehabilitation therapist, chaplain (if needed), psychologist, medical medical volunteers. Once a nurse asked me about one of the patients with respiratory failure. He wanted us to organise an oxygen cylinder for him to go fishing once more. It turned out that the patient was a keen angler. Of course, it worked out and the man went to the water with his family, and in the process dealt with official and banking matters. I would never have known about this need had it not been for the help of a nurse.
Medexpress: How does the pandemic affect the process of humanising medicine?
O.L: Twofold. On the one hand, it is a threat and a restriction, because it is dehumanising if we have restrictions on visiting. In the home setting, we tried not to use televisions and teleporades, but to visit patients. In the beginning this required more security measures. Once the vaccinations came in, we managed this problem. Our staff were already protected in this way. Palliative patients also already appeared after vaccination, their families and carers too. In the inpatient setting, this was not achieved. There were rigid recommendations to keep wards closed and not to let visitors in. On the other hand, we can take something good out of the pandemic period-we have improved ways of communication between the family and the doctor or nurse. Before the pandemic, the family could visit the patient and see for themselves, look at the patient and make conclusions (sometimes maybe wrong). Sometimes the patient told the family something they did not communicate to us. Now it is up to us to convey a picture of the patient's condition to the family in a reasonably artful way, although it is impossible to do so 100 per cent.
Medexpress: According to the CNN website, during previous pandemic waves, more elderly people staying in their own homes died than nursing home residents. What is your experience?
O.L: Theoretically, palliative care in Poland should be unlimited, something that the community has been fighting for for years. Unfortunately, there are restrictions. Perhaps one day this will change. Let me give you an example of our hospice, which has a contract for 7 patients, while we have 30-34 under permanent care. We know that there are areas in Poland where this deficit exists. Those who are not receiving this care are at risk of passing away quickly. This is what research has shown - palliative care, if done well, prolongs life. Home mortality may now be holding steady, but patients are admitted to the unit in a more severe condition than patients admitted before the pandemic. We are getting patients in a more severe condition and these are their 'shorter stays' with us. We observed another phenomenon - in the pandemic we were getting fewer patients than before. In the 'house' we had a queue, and here on the ward there was no queue.
Medexpress: What challenges do you see for the Doctor in areas related to palliative medicine, but also to the humanisation of medicine?
O.L: An issue that we are facing and will probably continue to face is that of euthanasia. We observe that this trend in various countries is beginning to be pro rather than anti. The European Society for Palliative Medicine, of which the Polish Medical Association is a member, upholds the view that euthanasia is not a form of solution. Privately, I will say that a patient's request to die is insanely rare. For us, if a patient talks about wanting euthanasia it screams of maximum suffering. It is unimaginable how such a person must suffer if he asks for such a solution. Therefore, you have to fight his suffering to try to find what is the reason that he has asked for such a solution. The second thing is that we are waiting for the progress of medicine, because many ailments in patients are 100 per cent manageable at the moment. However, when it comes to pain, for a certain percentage of patients its treatment is very difficult and the available resources, even at the highest level, may not be sufficient here. Certain organisational things would be good to improve, e.g. the overlap of services. It is, for example, the case that a patient admitted to us only goes for one chemotherapy. And we have to do some gymnastics, discharging the patient for more chemotherapy, because the two services (stay with us and administration of the drug) cannot be combined. And it would be possible to pay for both benefits at the same time. Another thing is the issue of benefit capping. If this could be circumvented, I think that the hospice would be able to accept more patients. Certainly the lack of staff is a concern, because although there is no shortage of staff at the moment, we can see that they are approaching the limit of retirement. And it's important that young people come to work for us, and it's not a speciality that's taking young doctors' minds off it. When I myself ask my students who is thinking about such a job, only two people come forward. This specialisation can be associated by young people with failure, because there is no cure effect in this care.
Source: medexpress.co.uk