Indian Journal of Anaesthesia

BRIEF COMMUNICATION
Year
: 2020  |  Volume : 64  |  Issue : 2  |  Page : 151--152

Talking the talk to walking the talk


Abhijit K Dam 
 Medical Director, Kosish-the Hospice, Pindrajhora, Jharkhand, India

Correspondence Address:
Dr. Abhijit K Dam
Qr. 2120, Sector 4 C, Bokaro Steel City, Jharkhand - 827 004
India




How to cite this article:
Dam AK. Talking the talk to walking the talk.Indian J Anaesth 2020;64:151-152


How to cite this URL:
Dam AK. Talking the talk to walking the talk. Indian J Anaesth [serial online] 2020 [cited 2020 May 25 ];64:151-152
Available from: http://www.ijaweb.org/text.asp?2020/64/2/151/277773


Full Text



It's been almost two decades that I have been practicing Palliative Medicine; perhaps longer, unconsciously, now that I reflect back. My journey through the twists and turns through the dimly lit lanes of Palliative Medicine were infused with an initial enthusiasm to learn and understand the concepts and to relieve suffering.

But then, sadly so, I had already been 'programmed' by the rigid system of modern medicine, tempered with scientific justification. Hence, a large part of my first decade in Palliative medicine was spent in acquiring new training in an effort to acquire further demonstrable qualifications to 'authenticate' my stature amongst my fellow physicians. What sadly followed was a 'structured' system of training, mostly theoretical with an increased emphasis being placed on completing assignments on time and ensuring that I 'pass'. The focus was more on therapeutics and 'mechanisms' rather than on the human being who was suffering. The slippery slope was being revisited, for we had already been 'programmed'. I was focusing more on publications, statistics, replying to queries on methodologies, assignments, catching up with deadlines; in short I had become a zombie. The free bird was now imprisoned in a new cage!

I was just 'talking the talk'.

Luckily, I woke up.

Most of the wizened Palliative Care professionals out there would understand what I am talking about. With the current system, the learning curve is steep and time consuming before we finally arrive at the realisation that what really matters is to understand yourself first and then transferring your compassionate presence to your patients and their families.

You need to fill up your own glass before you are able to pour out for others.

And yes, not everyone can be a palliative care professional. The underlying principle is 'compassion'.[1] This is a stream which is 'different' from the standard training offered in medical schools, where time, energy, money is spent on pharmacological and technological management and its advancement.

It is something like a big factory making cookies by the thousands daily with a focus on profitability, compared to a pitiful few cookies that are made with hand by your old granny at home, which are infused with love and compassion.

Non-pharmacological management,[2] which is the core of palliative care therapeutics, often takes a backseat. We talk of a holistic approach to care, but sadly devote scant time addressing the psychosocial and spiritual domains. For example, in the management of terminal dyspnoea, we are 'programmed' to respond automatically by starting oxygen therapy and administering medications; but what actually should be done is to be compassionate to the patient and the family members, reassuring them gently, assuring the patient that you will be taking care of him, staying beside the patient, holding his hand, gently rubbing his back, opening a window, switching on a fan to let the breeze fan his face…this approach goes a long way in providing reassurance to the patient and his caregivers and cuts down the vicious cycle of anxiety and dyspnoea. It is no wonder that in textbooks of palliative medicine, the non-pharmacological approaches to symptom management often get a backseat with a pitiful paragraph devoted to it. For discussing these issues requires us to 'walk the talk' rather than merely 'talking the talk'. This being a new skill, requires time and devotion to acquire. It also necessitates focused guidance and training, which sadly is lacking.

Here, there is no scope of 'cheating', for you cannot cheat yourself!

The wizened palliative care provider gradually stops being a physician, a mere 'treater'. Just like the larva which is imprisoned in its cocoon cannot liberate itself without an effort, a final trust, getting rid of its bondages and spreads out its beautiful wings to fly free, similarly we too should learn to fly free.

The transition from a 'treater' to a 'healer' thus happens.

We now begin to 'walk the talk'.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Fernando AT, Arrol B, Consedine NS. Enhancing compassion in general practice: It's not all about the doctor. Br J Gen Pract. 2016 Jul;66(648):340-1.
2Coelho A, Parola V, Cardoso D, Bravo ME, Apostolo J. Use of non-pharmacological interventions for comforting patients in palliative care: A scoping review. JBI Database System Rev Implement Rep. 2017 Jul;15(7):1867-1904. doi: 10.11124/JBISRIR-2016-003204.