Dr Malik Dinata is a trainee GP who has chosen to spend four months on rotation at St Luke’s Hospice in Plymouth, to see their service through his eyes and find out how his experience at the hospice will help to prepare him for his career in general practice. Here he shares what he’s learnt from the experience so far.
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At St Luke’s I’ve seen the “gold standard” and it will benefit my future practice – it will be my point of reference and remind me what I need to do for my patients.
Dr Malik Dinata
With people living longer and developing more complex conditions, having GPs who understand end of life care, and do not shy away from difficult but necessary conversations with patients about death and dying, is more important than ever.
Despite this, it isn’t mandatory for GPs to gain experience within hospice care as part of their training. Rather, it is an option they can select as one of the three rotations they are required to complete on their way to becoming qualified.
Dr Malik is based within the multidisciplinary clinical team at St Luke’s. He’s been particularly struck that the time he spends with patients on the ward is unhurried. This means he is able to focus on more than their physical symptoms, getting to know them and their history and finding out about their hopes, expectations and concerns – something that would not be possible within the very pressured environment of acute care.
He says: “It is very precious to be able to work with St Luke’s. I get to sit with my patient and practice medicine as it is supposed to be.”
Dealing with death, dying and someone’s last days of life can be one of the most stressful parts of a doctor’s role, and Dr Malik credits the support he receives from his supervisor, St Luke’s Lead Consultant Dr Jeff Stephenson, and other colleagues for ensuring he feels “safe and comforted” in a setting many would find very challenging.
“We always touch base before I see a patient so that we can discuss the approach that’s most appropriate for them, and then afterwards colleagues check in with me to ask how it went and how the patient responded” he explains.
On average, a GP surgery has 2,000 patients, with around 20 of them – one per cent – living with terminal illness. To help them be as comfortable and as at ease as possible as they approach the end of their lives, they need the specialist care and support of hospices, where the help they receive is holistic and tailored specifically to them.
Trainee GPs like Dr Malik, who spend time gaining valuable experience in a hospice setting, are not only more equipped to diagnose accurately and prescribe accordingly, they are more confident having the sensitive yet necessary open conversations about death and dying that help their patient fulfil their wishes about their last months, weeks and days of life.
Dr Jeff said: “Being on rotation with us is a wonderful opportunity for future GPs to gain intensive exposure to look after people who are terminally ill.
“Importantly, while they’re with us, trainees also learn when to admit a patient to hospital and when it’s more appropriate for them to receive care at home, which is key to avoiding unnecessary admissions.”
Dr Malik says the hospice has made a positive and lasting impression on him that he will carry forward into practice. “St Luke’s is such a unique environment where people, including the patients themselves, learn to become more accepting of their mortality.
“It’s so important for GPs to know how things should be done. At St Luke’s I’ve seen the “gold standard” and it will benefit my future practice – it will be my point of reference and remind me what I need to do for my patients.
“You don’t gain this type of valuable experience from reading about it in textbooks or hearing about it in lectures. You get it from practice at St Luke’s.”
