Palliative Care: Medicine for the “Moribund”?

This article was exclusively written for The European Sting by Mr. Guilherme Lerner Trigo, a 19 years old first year medical student in State University of Londrina, Paraná, Brazil. He is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

Commonly referred to as the medical area responsible for attenuating terminal patients suffering by “rushing death”, Palliative Care (PC) is, probably, one of the most misunderstood professions in the health field. While WHO defines it as “an approach that improves the quality of life of patients and their families who are facing problems associated with life-threatening illness (…) through the early identification, correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual” ^[1], people tend to associate it with inevitable death scenarios, which are the ones usually shared by media channels, leading to an irrational apprehension towards this medical specialty.

Although PC is growing interest among medical students, many carry the “medicine for the moribund” bias throughout their academic lives. A study conducted in UK medical schools (a top-rated country in PC global rankings), by Diver and Quince (2018), shows 16% of students in their final year expect PC to be less satisfying than other care ^[2]. The motive is simple: it is yet to be a valued subject in medical faculties. For instance, in Brazil, which has one of the most efficient universal health care systems in the world, PC was firstly instituted as a compulsory discipline on a public university in 2003 ^[3], meaning it is still quite new to discussion. The outcome to this frustrating background is a lack of professionals for this medical specialty (in the U.S., for example, there were only 4400 physicians working in PC programs in 2014 ^[4]) due to fear of having several patients dying in their own cares, one of the biggest obstacles in granting its universal access.

Advocating for Palliative Care in universal health care is advocating for the implementation of mandatory PC subjects in medical schools. Unlike what some might believe, inserting this subject in the curriculum can promote heavy improvement in students’ anamnesis and communication abilities. Furthermore, it also comprises bioethics and its implications on modern medicine, in which patients are given the possibility to live significantly longer yet need to have their quality of life reassured ^[3]. However, the most important aspect in PC is to fully evaluate your patient, meaning the student must learn to investigate its physical, cultural, psychological and spiritual characteristics.

The exposure of medical students to this subject is the best way to demystify the specialty, a great path towards showing it has much to offer other than “rushing death” or relieving a terminal patient’s pain. According to Costa and Poles (2016), the PC discipline was able to successfully change their student’s perception about the specialty, citing many thought palliativists were only summoned when patient’s death was imminent. It also helped them develop higher rationality towards the medical cases, preventing greater involvement ^[5].

In order to grant universal access to Palliative Care, the profession must be in higher demand amongst future physicians. Recruiting will be necessary, and it starts by assuring mandatory PC subjects in medical schools in an attempt of teaching the specialty’s real complexion and eliminate biased criticism and fear towards it.

References

1. https://www.who.int/news-room/fact-sheets/detail/palliative-care
2. Diver R, Quince T, Barclay S, et al

Palliative care in medical practice: medical students’ expectations

BMJ Supportive & Palliative Care 2018;8:285-288.

• CALDAS, Gustavo Henrique de Oliveira; MOREIRA, Simone de Nóbrega Tomaz  and  VILAR, Maria José. Palliative care: A proposal for undergraduate education in Medicine. Rev. bras. geriatr. gerontol. [online]. 2018, vol.21, n.3 [cited  2020-12-22], pp.261-271. Available from: <http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1809-98232018000300261&lng=en&nrm=iso&gt;. ISSN 1981-2256.
• The Growth of Palliative Care in the United States Mark T. Hughes and Thomas J. Smith Annual Review of Public Health 2014 35:1, 459-475
• COSTA, Álvaro Percínio; POLES, Kátia  e  SILVA, Alexandre Ernesto. Formação em cuidados paliativos: experiência de alunos de medicina e enfermagem. Interface (Botucatu) [online]. 2016, vol.20, n.59 [citado  2020-12-22], pp.1041-1052. Disponível em: <http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1414-32832016000401041&lng=pt&nrm=iso&gt;.  Epub 03-Maio-2016. ISSN 1807-5762. 

About the author

Guilherme Lerner Trigo is a 19 years old first year medical student in State University of Londrina, Paraná, Brazil. He is a recently admitted IFMSA BRAZIL UEL member, interested in social projects related to medical subjects. He hopes to become a complete physician in the future, aware of people’s needs regardless of their social-economics class, as well as capable of assisting anyway possible. Engaged in scientific projects, he is also fond of studying public health matters. This article is his submission on the topic “Palliative Care and Universal Health Coverage: how to advocate for the inclusion of palliative care in UHC”.