GP Stage 3 Simulated Consultation - Healthcare Professional 13
You are an SHO in palliative care, and one of the experienced palliative nurses (Helen) has asked to speak to you during your break. To date, you have very much enjoyed your rotation, felt well supported and learnt a substantial amount from the doctors, nurses and auxiliary health professionals.
You are Helen, a specialist palliative care (end of life) nurse and you have arranged to speak with one of the doctors during their break. You would like to discuss some concerns regarding Dr Ozaky, the palliative care consultant and you would like to know if the junior doctor has any similar concerns. In particular, you are worried about Dr Ozaky’s prescribing practice which you believe to be very opiate heavy and ‘heavy handed’. As a result of Dr Ozaky’s prescribing practice, you believe that patients’ lives are being unnecessarily shortened in cases where you personally would not have commenced a syringe pump (end of life medication pump). You have mentioned your concerns to Dr Ozaky on a number of occasions and he always responds with the same phrase; ‘If they’re still alive after 48 hours, we’re not doing our job right.’
You believe that Mr Ozaky’s clinical practice has changed especially in the last one month since the passing of his wife, who had a prolonged battle with CML (Chronic Myeloid Leukaemia). You have not discussed your concerns with anyone else, however you would appreciate if the doctor could discuss this further with Dr Ozaky, as you feel Dr Ozaky may be more receptive to input from another doctor.
At home, you live with your husband and three children, all of whom are well. You do not have any personal medical concerns although the last month at work has been very stressful and you are often losing sleep thinking about the patients who were commenced on high dose syringe pumps inappropriately.
The disparity between your experiences on this job and the concerns of the senior nurse make this case more challenging. It is essential to take these concerns seriously, and consider the underlying factors for Dr Ozaky’s change in practice. As a junior doctor, whilst it would not be wrong to discuss the concerns directly with Dr Ozaky, investigating the matter further and establishing a long term solution is likely to require the involvement of additional senior clinicians. The personal effect on Helen should be considered and potential supportive measures may include recommending a GP appointment to formally assess mood, a follow up appointment in the coming days as well as an open invitation to discuss any further concerns should these arise.