Volume 23, Number 10: October 2022
A Small Book Abounding in Sage Advice from a Palliative Care Veteran
Some Notes for Physicians Contemplating a Career in Palliative and Person-Centered Care
Eduardo Bruera
University of Texas MD Anderson Cancer Center, 2019
84 pp, eBook
ISBN: 9781733329705
To get a free copy, email your request to [email protected]
Reviewed by Frank Brennan
Palliative care physician, Sydney, Australia
Over time, the literature on palliative care has grown considerably. Most of that literature has concentrated on the patient experiencing the illness, and their family. What about ourselves as health professionals? The concept of self-reflection always lies beneath the surface of our professional lives. It is natural that it does so, given the importance we place on the psychological and spiritual dimensions of illness in our patients and their families. Indeed, that emphasis would ring hollow if we ignored our own response to this work.
Entering the domain of palliative care for the first time can be challenging. We may be confronted into silence by suffering, sorrow, and dying. Little truly prepares us for that moment. Dr. Eduardo Bruera addresses this book to physicians who may be contemplating a career in palliative care. Bruera, a renowned researcher and thinker, has contributed widely to the understanding and practice of the discipline. Appropriately, in this book, he pares back language to the “unapologetically colloquial.” This master of the technical speaks with a personal voice. Deliberately, he steps beyond the usual educational topics in palliative medicine into the territory of wisdom. This wisdom is clearly drawn from experience. As he states: “some of the most valuable learnings from my career did not come from medical readings or my research, but rather from the observation of colleagues in different roles, my own medical practice with patients and families, non-medical books, and career decisions…”
In brief, accessible chapters he examines why physicians may gravitate toward specializing in palliative care, the role of the physician in a multidisciplinary team, the elements of good and poor teamwork, healthy interaction with other non-palliative care colleagues, the habits that may lead to or protect physicians from burnout, leadership in medical institutions, mentorship, research and the art of giving engaging presentations. Throughout, Bruera reflects honestly on the challenges that palliative care clinicians face and common mistakes made.
The chapter on communication is full of sound, often overlooked, recommendations distilled from years of experience. These include:
- sit when you see a patient (as the great Spanish physician Gregorio de Maranon said, “the best medical instrument is the chair”);
- always examine the patient (Bruera points out both the practical and symbolic importance to the patient of being examined by a physician);
- do not use an Electronic Health Record computer in the patient’s room;
- provide an audio recording of appointments for outpatients to replay later;
- put some art on the ceiling (so that bedridden patients can see it); and
- play music in common areas.
This unique book—part self-reflection, part wise counsel, part sage advice—is worthy of close reading not only by its target audience, but all clinicians, irrespective of their seniority, working in palliative care.
Eduardo Bruera, MD, is the F.T. McGraw Chair in the Treatment of Cancer, and chair of the Department of Palliative, Rehabilitation, & Integrative Medicine at University of Texas MD Anderson Cancer Center.
Dr. Frank Brennan is a palliative care physician, past president of the Australian and New Zealand Society of Palliative Medicine, a senior lecturer in the Faculty of Medicine, University of New South Wales, and a lawyer. His special interests include kidney disease, motor neurone disease, and the human rights dimensions of pain management and palliative care.
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