Essays by IAHPC Board Members

How to get your papers published: part II

The second of my inspirational books is “Talking Sense” by Richard Asher. Asher was a consultant physician in London and died in 1969, a year before I qualified in medicine. In the blurb on the outside cover of this book, Richard Asher is described as “one of the most outstanding medical thinkers of our time: a brilliant writer with a sparkling and devastating wit; and a distinguished clinician”. The book is short, less that 200 pages, but you can immediately tell it is important because it is edited by Sir Francis Avery Jones (the father of gastroenterology), has a foreword by Professor Lord Rosenheim, President of the Royal College of Physicians and one of a handful of medical Fellows of the Royal Society, and an introduction by Professor William Bean, Professor of Medicine in the University of Iowa, three distinguished physicians of world renown.

I can remember Lord Rosenheim talking about Asher and his writing at Grand Rounds at University College Hospital. I was House Physician to Lord Rosenheim in 1970 and he had been a close friend and admirer of Richard Asher and encouraged both his junior and senior colleagues to search out his papers.

That is the background: what of the book? It is a collection of Asher’s most important papers and is a marvellous tour de force. This is a really enjoyable book to read and every time you do read it you are bound to learn something new or relearn something that you had forgotten.

My intention in writing these short articles was to give you advice about getting your papers published in scientific journals. One particular chapter in this book covers this subject and in fact the essence of the chapter is eloquently presented in the first four lines in the form of a poem by Rudyard Kipling.

“I keep six honest serving men

(They taught me all I knew);

Their names are What and Why and When

And How and Where and Who”

Rudyard Kipling

Asher comments: “Kipling’s poem gives an admirable summary of the way we get most of our knowledge.” Most scientific enquiry is based on those six monosyllables, and the orderly presentation of a scientific paper is helped by trying to answer the six questions they pose. In this paper on the writing of articles for medical journals, I am going to write as if you know nothing about the subject and as if I know everything, because I find it easier to write in that way. In fact, you are probably a capable writer because the people who can write are usually those who read about how to do it. They are the people with well-used copies of Complete Plain Words by Sir Ernest Gowers and Fowler’s Modern English Usage.

Asher goes on to say “you need not read this if you can write, but you probably will; and if you can’t write, you ought to read this but you probably won’t”. Whether you can write or not you will enjoy this book and your writing is bound to improve.

I have been able to include just one or two examples from the two books I have written about but I hope a coherent message is already apparent. Simple English is a much more effective use of the language than complex English, and being brief enormously enhances understanding and learning. The Editor has indulged me and found space for a third and final piece, which will follow soon.

Professor Geoffrey Hanks

Professor Hanks’ biography may be viewed at http://www.hospicecare.com/Bio/hanks.htm

What do we mean when we say that caregivers are part of the unit of care?

Care giving is not an easy task in any circumstance let alone when someone is dying. Palliative care has continued to assert that caregivers are part of the ‘unit of care’. The evidence to support that palliative care services have genuinely operationalised this definition is actually difficult to find.

Work over the last few years has defined caregivers both in terms of their relationship to the person with the life-limiting illness and to the level of care. In addition to caring for someone with a life-limiting illness, there are the other responsibilities that caregivers have in life – caring for other people in the same household, working, or keeping house. Clearly all of these things have the potential to impact greatly on a person’s ability to provide care and to ‘move on’ from that role having completed that care.

Many people clearly feel under intense pressure from family and friends to provide care. Although the majority of people reflect that their care for someone at the end of life is a wonderful opportunity to provide support for a fellow human being, some people not only find the role difficult and challenging, some caregivers actually resent it.

As palliative care service providers, it is imperative that we understand the circumstances in which this person came to be a caregiver. Unlike so many other areas of clinical or social caring, there is rarely a ‘start date’ for caring for someone at the end of life. It is much more often a subtle progression into the caring role as a person’s dependence on caregivers gradually increases over time. This subtle transition is a major challenge. Many people providing quite intense care would, as a result of the ambiguity of this transition, not identify themselves as caregivers. Because they do not see themselves as caregivers, they may not reach out for help from family and friends or from services set up to provide support for them.

For palliative care the challenge is to:

a) identify caregivers often before they consider that they are in the role; and

b) provide targeted supports specifically for caregivers independently of patient assessment.

Most often support for caregivers is only framed in the context of the patient but there are increasing arguments that such assessment and support need to happen directly and specifically for caregivers. This is not diverting care from patients but is an adjunct that needs to happen systematically given documented levels of unmet needs by caregivers. The assessment and care are specifically aimed at carers themselves. If this can be achieved, then we may come part way to operationalising the needs of carers in ways that can improve health outcomes for carers. While in the role and having relinquished the role, the health of caregivers is measurably worse than if they were not in the care giving role.

As we talk about caregivers being part of the ‘unit of care’, we must look to their improved physical and psychological health throughout the time they provided care and in the years after they have provided care if we are to truly ensure the best possible outcomes are available.

Professor David Currow

Discipline of Palliative and Supportive Services Flinders University, Daw Park, South Australia, Australia.
Professor Currow's biography may be viewed at http://www.hospicecare.com/Bio/currow.htm