HUNTER hospitals are ‘‘badly prepared’’ to provide end-of-life care to the thousands of patients who need it each year, an intensive care specialist says.
Dr Peter Saul has called for a radical shift in the way we think about dealing with death.
About 3300 people die in Hunter New England hospitals every 12 months.
Working at the Calvary Mater, John Hunter and other hospitals in the region, Dr Saul sees more than 200 people die each year.
‘‘Over half the people in Newcastle ... will die in John Hunter or the Mater and that’s just the way it is,’’ he said.
‘‘The fact those hospitals are as badly prepared for that as they are is a shame.’’
Dr Saul said healthcare professionals focused so much on trying to find a cure or making a patient better they ignored having a conversation about death until it was too late.
‘‘We’re not unusual or unusually bad [here in the Hunter],’’ he said. ‘‘It’s just that it’s the case everywhere – it’s an international issue.’’
Dr Saul said there was a perception that caring for the dying was mainly related to specialist palliative care – but not many people got to access such a service.
‘‘The great majority of people who die, die without ever seeing a palliative care person,’’ he said.
‘‘In intensive care I see as many dying people as they do in a hospice.
‘‘Most of the management of dying, which is like the last year of your life, has nothing to do with palliative care anyway.
‘‘It has got more to do with other forms of support for people, conversations that have to be had, getting people’s affairs in order, working out who makes decisions for people, seeing if people have any wishes that they wish to talk about, these are all important.’’
Dr Saul said it was becoming more common for intensive care units to look after 80-year-olds with conditions such as pneumonia.
It shouldn’t come as a surprise that these people were at the end of their lives but often no one – their GP or specialist or even family – had talked about the prospect of death.
‘‘This isn’t a population of people that couldn’t have talked about it,’’ he said.
‘‘Many of the people who come and die in ICU have been dying for quite a long time already.’’
By the time people got to intensive care, however, it was too late.
Often the reality of death was not acknowledged until the very end.
‘‘There’s no time for preparation or putting your affairs in order,’’ Dr Saul said.
Hunter New England practice development officer for end-of-life care, Lisa Shaw, agreed the management of death was an issue.
She said there was reluctance among nurses and doctors to sit down and talk to families about the reality of the patient dying.
She said what she and Dr Saul were advocating had nothing to do with euthanasia.
‘‘About 75per cent of the population that die, they show signs of that dying in the months leading up to that death,’’ she said.
‘‘It’s a matter of people looking out more and being prepared to say, ‘I think you’ve only got a year or so to live’.’’