Acute medical care is limited in nature and is sometimes unable to
address the broad needs of very ill and dying patients. Palliative
medicine offers a holistic approach to care and expertise in symptom
control that might not otherwise be available. A palliative care
team is often able to help patients rekindle hope at a difficult
stage of their lives, assisting them to recognise choices that are
available and to find the best way forward in situations that are
often changing rapidly. Work in the specialty is very rewarding.
An ability to function within a team and work alongside other health
care professionals is important. Enthusiasm for teaching is
valuable, since the teaching of health professionals (both formally
and informally) is inherent to the job. It is important that you
should have good clinical skills for assessment and diagnosis, and a
range of medical and life experience. Interpersonal, communication
and listening skills are vital, and you need to feel confident about
addressing and negotiating difficult ethical issues that you might
encounter. To make a career in this field sustainable you need to be
able to seek appropriate personal support and make self-care a
priority.
The daily schedule varies depending on whether you work in an acute
hospital or in a community setting. The majority of specialist
palliative care posts at present are community based within hospice
services that may or may not have inpatient beds. As a specialist
you may provide medical support for hospice inpatients, community
palliative care nurses, general practitioners, and patients in
day-stay or clinic settings. Many of the main cancer centres have
dedicated hospital palliative care teams. As a member of one of
these teams you would expect to work consultatively with palliative
care nurse specialists, primarily in the acute setting.
Palliative medicine has only recently been established as a
subspecialty, with vocational recognition by the New Zealand Medical
Council in 2001, supporting two ways to Speciality training, namely
the Australasian Chapter of Palliative Medicine and RACP-Palliative
Care programmes. There is currently a shortage of palliative
medicine specialists both in New Zealand and internationally.
Major challenges that face the specialty include integrating more
closely with mainstream medicine without losing the broad approach
to care or becoming merely a specialty of symptomatologists;
becoming more involved with teaching at pre- and postgraduate levels
for a wide range of health professionals; securing funding for
essential palliative medicines not readily available at present; and
providing palliative care to disadvantaged dying patients such as
those with non-malignant illness and those in residential care.
It is recommended that you should talk with those who are actively
involved in palliative medicine and work with them if possible.
Further information can be found in the RACP handbook Requirements
for Physician Training (Adult Medicine, New Zealand), and in the
Palliative Medicine Training Manual published by the
Australasian Chapter of Palliative Medicine.
New Zealand is following the trend set in Europe and Australia, with
growing recognition that specialist palliative care can improve
choices and quality of life for people with malignant or
non-malignant incurable illness. The New Zealand Palliative Care
Strategy Document made palliative care an area of priority, although
it is not yet apparent whether there will be sufficient funding to
enable significant development of services. It is likely that there
will be an increase in job opportunities over time.
Taking time out from work in palliative medicine is feasible as is
part time work in both hospital and community settings. There are
also good opportunities to gain experience and training overseas.
The work is intense and the field is under resourced so there is
risk of burn-out if you are not able to set reasonable boundaries
and look after yourself adequately.
Several centres are in the process of investigating issues
related to funding and training and training posts are being
established in some centres in New Zealand.
