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Palliative care’s becoming an elaborate game of Cluedo

Ah, remember terminal care in the good old days? Armed only with a prior knowledge of the patient and a syringe driver of morphine, and mercifully untroubled by outside interference, you really felt you were achieving something (note for confused younger readers – this was before the word ‘achievement’ became inextricably linked with the acronym ‘QOF’).

Now, I know that only tedious old farts would say, ‘It’s not like that now,’ but, hey, it’s not like that now. It’s become yet another tick-box exercise where judgement and compassion have been supplanted by regulations and bureaucracy.

I know this because I have a) A patient dying of lung cancer and b) Two forms sitting on my desk. They’re not the only forms I’ve had to complete – I’ve signed the Liverpool Care Pathway, the drug regime (in triplicate) and so on, the net effect being I’m pen-pushing rather than palliating. But these two forms are the most vexing.

One is the ‘Cardiopulmonary resuscitation’ form. It has 15 boxes to complete or tick, which is odd, because I’d have thought it would be a straight ‘yes’ or ‘no’. Apparently, if an ambulance is called to the patient, the crew is ‘obliged’ to attempt CPR unless we have one of these forms to wave in their faces, because, while paramedics are highly skilled and totally dedicated, their superiors clearly regard them as too stupid or too inhumane to be able to exercise discretion. I’ve been told that this form has to be updated fortnightly, otherwise it’s no longer ‘valid’ – and a tiny part of me believes this could actually be true.

The other form is the ‘Preferred priorities for care notice’. Thirty six bits to complete or tick, including, no kidding, ‘They wish their place of death to be at....home/care home/hospice/hospital’ - which turns palliative care into a game of Cluedo.

So, anyway, with a heavy heart, I’m filling out these forms, and it takes forever. In the middle of my scribblings and mutterings, the phone rings. Guess what? My patient has died. Is it possible to put ‘irony’ as the cause of death on the certificate? I’ll let you know.

Dr Tony Copperfield is a GP in Essex.


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