Essays by IAHPC Board Members

Last month Dr. Derek Doyle provided us with Part I of an essay So - what’s new ? A Personal View. Part 2 follows:

Behind this bold statement lie many challenges, challenges every bit as daunting as those which confronted the pioneers of palliative care in the 1960s and 70s. . ‘What are those challenges?’ you ask.

Firstly, you must recognise that the features of all good care (not just the technical details of palliative care) need to be stated and restated in the loudest terms in all our teaching. We can never speak often enough about, or demonstrate, those fundamental principles of skilled listening, gentle examination, sensitive explaining, eliciting details of hidden suffering, and knowing how to care for the relatives as we hope people will do for us when that time comes. As things are going, we may soon find we are the only clinical teachers who address these matters. A doctor whose wife had just been admitted to a palliative care unit said to me recently how good it was to see a young doctor not only carrying a stethoscope but actually using it – his wife had just been in a famous tertiary referral hospital and had had countless blood tests, MRI, CT scans, but never had a physical examination and no doctor had ever sat beside her to explain that she was being transferred to the palliative care unit.

I recently visited a friend in a hospice and asked what he thought of it. “It’s great not having to apologise all the time as I had to do in…(and here he named a famous teaching hospital). “Sorry to trouble you but could someone help me to the toilet – I know you’re busy.” “I really am sorry for troubling you when you are so busy, but can I have something for this pain which is almost unbearable?” “ Nurse, I don’t know if you realise that I have had nurses tick boxes on that questionnaire three times today already. Sorry if I seem uncooperative.” “Here in hospice I feel important, if you know what I mean, and no matter how busy they all are, and they really are rushed off their feet, they always have time for me.”

Secondly, you must have the courage to stand up to those who, however well-meaning, would initiate or impose changes in clinical practice which might isolate patients, erode their sense of safety and autonomy, widen the professional / patient gap, and make communications more difficult. Look around most general hospitals and you will know what I mean.

Lastly, never apologise for the “soft” side of palliative care. The fact that such softness and gentleness is less often seen today outside of palliative care is a reminder to us that its demise is partly responsible for much that has gone wrong in our care systems. The rigours of academia and modern research are not the antagonists of palliative care. They can be symbiotic.

So what’s new?  Nothing!  Compassion and empathy, listening rather than talking, have been the hallmarks of a caring society since long before someone coined the name Palliative Care.

So what’s new? Just the name!

Derek Doyle
Edinburgh, Scotland

Dr. Doyle is a life member of the IAHPC Board. His biography may be seen at the following link http://www.hospicecare.com/Bio/d_doyle.htm

How to get your papers published

I have often been asked over the years for tips about getting papers published. I thought I could usefully pass on what I believe is one of the most important pieces of advice. That is to write plain English.

English is a language that in certain respects we all share. Certainly it is the main language of scientific communication globally. For many people reading this, English will not be your native language, but the message and the principles of what I have to say will be the same whatever your language. Effective communication is one of the core skills of palliative care practitioners but it doesn’t just happen – it has to be worked at.

When I was a boy I wanted to be a writer and particularly a journalist and throughout my career in medicine writing has been an important part of my day-to-day life. I used to read books about writing and even enjoyed reading about English grammar so that I could write correct English, in the belief that correct English is most likely to be effective in communicating my thoughts to others. I thought I would mention three books which have inspired me to constantly strive to be a better writer. The first book has an unlikely publisher: Her Majesty’s Stationery Office (HMSO). The Majesty referred to is of course our Queen Elizabeth. She didn’t have anything to do with HMSO which was a government department which published official reports, papers and books from every department of government in the UK. The title of the book I had in mind is The Complete Plain Words by Sir Ernest Gowers, subsequently revised and updated by Sir Bruce Foster (in 1973!). These distinguished scholars of the English language were engaged by the government after the Second World War to improve official English. The government in a very enlightened way thought that it was important that letters from officials and all other communications from government to the people should be of a high standard. The book began life as Plain Words and first appeared in 1948. It soon became standard reading for all civil servants (workers in government) but was reprinted many times and soon became widely read in all areas of society. Gowers explains in the preface of the book that it is not a grammar of the English language, but is “wholly concerned with the choice and arrangement of words in such a way as to get an idea as exactly as possible out of one mind into another”. The book is surprisingly readable and witty and in fact a brilliant classic text. It is full of quotations and aphorisms which in a few words or lines illustrate rules and maxims which form the basis for effective communication. “After all”, said Lord Macaulay “the first law of writing, that law to which all others are subordinate is this: that the words employed should be such as to convey to the reader the meaning of the writer”. Gowers comments that the golden rule is to pick those words and to use them and them only. Arrangement is of course important but if the right words are used they generally have a happy knack of arranging themselves. A brief look at the contents pages of the book gives a clear indication of the main messages. For example, chapter 3 has a section on how to draft a letter and outlines three fundamental precepts: be simple, be short, be human. In the next chapter is added a fourth precept: be correct.

Gowers went on to update another classic text on the English language, Fowlers Modern English Usage. The Complete Plain Words is still in print, but HMSO is now called the Office for Public Sector Information. The book is readily available.

I started this piece by saying that I was going to tell you about three books which have inspired me to write better English. I am afraid the Editor tells me I have run out of space so will have to save this for another occasion.

Geoffrey Hanks
Emeritus Professor of Palliative Medicine, University of Bristol
Editor-in-Chief, Palliative Medicine

Professor Hanks is an IAHPC Board member and his biography may be viewed at http://www.hospicecare.com/Bio/hanks.htm

The reader may find it of interest to read The Complete Plain Words online at: http://www.ourcivilisation.com/smartboard/shop/gowerse/complete/index.htm