Dr. Doyle receives Lifetime Achievement Award from American Academy of Hospice and Palliative Medicine
Dr Derek Doyle’s response on receiving in absentia the 2005 Lifetime Achievement Award of the American Academy of Hospice and Palliative Medicine (AAHPM). This was presented on DVD to the Annual Convention of the AAHPM in New Orleans 20 January 2005 where Liliana De Lima received the award on Dr Doyle’s behalf.
Hello to you all. Good morning.
Please accept my sincere apologies that I cannot be with you in person. Nothing would have pleased me more than joining you all in New Orleans but I would not dare disobey my cardiologist.
Getting this prestigious award surprised and thrilled me more than I can begin to describe. My immediate reaction was that you had mistaken me for someone else, or that you thought I had done more in life than is actually the case! I remain puzzled why you chose me but nevertheless am delighted. Just working in palliative care is itself such an honour and so rewarding that anything extra is a huge bonus.
Jim Cleary tells me that my leading the editorial team of the Oxford Textbook of Palliative Medicine was one reason for honouring me. In that case I am getting an award for having had a lot of fun, for working with some of the best people in the world, and for getting a chance to learn new things every single day. Editing such a book meant surviving countless computer problems and also working with a great team of copy editors, printers and publishers in South India where the book was produced.
Jim also suggested I say a few words, perhaps distilling just a few of my thoughts after 35 years in palliative medicine. I am delighted to do so. If I bore you don’t hesitate to fall asleep – I won’t be able to see you. I have a few anxieties about the direction in which we are going and about some of the things that are happening. Let me share them with you.
The first is that we are fast becoming experts in the clinical pharmacology of pain and symptom management more than in relationships and ‘total caring’. May I remind you that the first “modern” hospices were formed in the late 1960s largely because of published consumer opinions – the expressed disappointments and disillusionments of patients and relatives about what today we call “ end-of-life care” There is no denying that one recurring theme was poor symptom control. The other was the medical profession’s apparent lack of interest in how patients and carers felt, what they feared and needed to know, how lonely, unwanted and neglected they felt and how insensitive we doctors often were. What the patients craved for was companionship, evidence that even in their dying they were still valued, appreciated, wanted and even ‘useful’ in our materialistic and secularised society. Today I wonder if we are in danger of over-emphasising physical comfort at the expense of the “softer” side of palliative care, the one-to-one relationship with the dying. I suggest to you that palliative medicine should be an exercise in befriending and sharing as much as an exercise in therapeutics or clinical pharmacology.
My second anxiety may sound like a contradiction of what I have just said. There is a very real danger that in a few years’ time palliative care and palliative medicine will be the least “evidence-based” subject in medicine unless vastly more research is done. If that happens we will lose the respect of colleagues in other specialties and the quality of our care will inevitably suffer. We simply have to do more research of the highest possible quality. Doing so will not be a denial of our holistic approach. Science and compassion are not mutually antagonistic, as some seem to think. Objectivity and subjectivity can and do co-exist. In fact in our work they can be synergistic.
I remain anxious that, unthinkingly, we make claims that are not always true. For example, is our approach always interdisciplinary or is it sometimes more an exercise in which palliative medicine doctors delegate tasks and responsibilities to others? Every day we hear of nurses and therapists doing things that were traditionally done by doctors but how often do we hear of doctors taking on some of the roles traditionally done by others? Is all this to enable doctors to do their work better and provide better care, or is it to reduce their workload? We claim that palliative care is always holistic but do most of us have as much training and skill in spirituality as we have in pharmacology? Do we see that aspect of our work as intuitive, something that flows naturally from our own faith and philosophy? If we do, I suggest to you we are deceiving ourselves. How many of us have been trained in the humanities? How many of us feel competent and confident in caring for people from different cultures and creeds? If we look at what is happening in the world around us today the answer must be that none of us has a right to feel either competent or confident with regard to cultures and creeds different from our own.
Lastly – some of you can waken up now – I remain concerned that millions, (yes, millions, not thousands) millions of people have no access whatsoever to palliative care services or even to doctors and nurses who have learnt anything about palliative care. Some of these deprived people are in our own countries in the West because we have done so little to get palliative medicine into the curricula of all our medical schools. (Fewer than 10 countries in the west can claim that palliative care is taught in all their medical schools.) Most of the deprived are in the less affluent, less sophisticated countries – those that we patronisingly call “developing countries.” Why are we not doing more for them? Do we want palliative care to be regarded as one of the luxuries we in the West take for granted – something that you get when you have already had the best that modern medicine, surgery and oncology can offer?
Could it be that most of us don’t even know how desperate is their need – not only can they seldom hope to cure - they often have little modern equipment, few modern drugs and little of the means and the knowledge to alleviate appalling suffering? Why are we not twinning our units with some abroad? Why are we not offering to visit them and share what little we know? Are we frightened that they will see our approach to them as further evidence of interference or liberation by the West?
Believe me, if we do it more prepared to learn than to teach, more ready to share than to patronise, and do so without paternalism– our colleagues abroad will welcome our friendship and the spirit in which we share ourselves with them. It is for that reason I see the International Association for Hospice and Palliative Care as so important. Unless we act now we shall go down in history as yet another example of the West’s self-centered indulgence when, as you and I know so well, access to palliative care is a basic human right, not a luxury.
Let me urge you to keep palliative care simple rather than increasingly sophisticated, never to forget why it started, and, in this age of apathy and cynicism, to remain as excited about it in the days to come as you and I were when we first came into this work.
I often feel we live in a world endangered by four things -apathy, cynicism, materialism and fundamentalism; fundamentalism that might be economic, political or religious. Fundamentalism sees everything in black and white and knows no shades of grey, nothing between right and wrong, them and us. Out of fundamentalism , whatever its basis, spring arrogance, insensitivity, self-righteousness, and inhumanity to our fellow men and women Palliative care is one answer, one response to those dangers facing our society. It focuses on the individual and proclaims to each man and woman in our secularised, materialistic world: “You matter - not because you are dying, not because you are a clinical challenge to us, not because you are a shareholder - but because you are you!” We owe it to the world to share all we know and all we love about palliative care. If we in palliative care and palliative medicine fail to look beyond our shores we shall deservedly die.
Again – thank for your kindness and this great honour you have bestowed on me.
Derek Doyle
(Scotland)
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