Five most commonly asked questions in palliative care consultation

Restless, devastated and unable to adjust with their detoriating condition, patient and their caregivers are often overwhelmed with multiple queries. But not everything has an accurate answer, says Dr Sunil Dhiliwal
(the senior Consultant in Pain and Palliative Medicine at the prestigious hospitals like ACI Cumballa Hill hospital, HCG Cancer Centre and Kohinoor Multispecialty Hospital, Mumbai. He is one of the most respected and very experienced consultant, practicing palliative and supportive care management at both levels- hospital and home setup since more than a decade)
The first most commonly asked question by the patient/caregivers is
“if I agree to palliative care does that mean ‘I AM GIVING UP?’
and my reflex reaction immediately is NO, ABSOLUTELY NOT! Further I explain them that the goal of palliative care is to make you comfortable and help you achieve the best possible quality of life. You can have palliative care while you are undergoing treatments that may cure or reverse the effects of your illness.
In fact, Palliative Care can help you cope with aggressive treatments by getting your pain and symptoms under control to help you fight the disease. Palliative care also helps patients to complete their disease related treatment. Palliative Care management is not at the end; it is right from the diagnosis of the life limiting illness like cancer.

Most of the patients second important question is
Could I be addicted to the medication used for my pain and other symptoms?
My straight answer is No.
Addiction to medication prescribed for pain relief is a common fear, but is highly unlikely. Palliative Care Doctors are experts in preventing problems and side effects of strong pain medications.

The third commonest question asked is
“Could taking pain medicine hasten my death?”
With a very calm voice I say them No.
Appropriately prescribed medicine will not hasten death.
The Palliative Care Doctors are the experts to provide you the treatment plan that makes you comfortable, and is safe.

The fourth question really annoys me and also proves the low level awareness of palliative care in our city (Mumbai) despite being one of the best cities in India. The question is “How do I know that the palliative care is right for me”?
Palliative care may be right for you if you are experiencing pain, distress and other symptoms due to any life-limiting illness.
Life-limiting illnesses include but are not limited to: Cancer, Cardiac Disease, Respiratory Disease, Kidney Failure, Neurologic Conditions, etc.
The focus is on symptoms, pain, distress, etc. Palliative care is appropriate at any stage of a life-limiting illness and you can get it along with treatment meant to cure you.

The fifth and most difficult question asked by the patient/family is
“Can we take alternative medicine to cure the disease as there is no treatment in allopathic medicine system now?”
Imagine the hope one carries in the heart. And when all is not well, you tend to listen even the slightest, even when you self-question oneself and the answer is NO, but the HOPE takes the upper hand and you walk on the path may not be right for your patient. Yes, alternative medications (taken from the doctor) do have role to play in relieving the suffering but in advanced stage ‘curing’ is NOT AT ALL POSSIBLE. Alternative medicine does have role in building the immune system but not otherwise. It is strange that even the learned well-read people fall prey to the quack practitioners and ruin the name of the traditional medicine.

The basic principle to be followed is to befriend the illness, accept the fact and work towards improving quality of life by taking care of the existing symptoms rather than focussing on the disease advancement and trying to get it cure.

I remember a 32year young male with advanced head and neck carcinoma on PEG feeding with tracheostomy tube, asked me at the end of the consultation with a gentle smile “Will I be able to whistle after taking palliative care treatment?” I politely just counter questioned him with a teasing face and eye brows raised “were you whistling before having this disease?” very calmly he nodded his head sideways and said ‘NO’, but I always wanted to learn it….
That day, this thought of learning to whistle was running in my mind throughout, as in my college days even I wanted to learn whistling and I could not learn till now, may be this weekend I will try.

Details of AuthorDr Sunil Dhiliwal
Consultant Pain & Palliative Medicine
ACI-Cumballa hill Hospital, Mumbai
HCG Cancer Centre, Mumbai
Kohinoor Hospital, Mumbai
Head, Dr Dhiliwal’s Pain & Palliative Care, Mumbai
Email: [email protected]
Website: www.painpalliative.org