Doctors 'have no idea how to look after dying patients' and ignore their spiritual needs Medical experts claim basic humane for the dying has been forgotten

Their comments came at a discussion about the Liverpool Care Pathway The LCP guidelines were scrapped two years ago following Mail coverage

Experts: Good palliative care is about addressing psychological needs too

By COLIN FERNANDEZ FOR THE DAILY MAIL

PUBLISHED: 00:58 GMT, 4 September 2015 | UPDATED: 10:32 GMT, 4 September 2015

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Basic humane care for dying people has been forgotten by doctors because modern medicine is fixated with a ‘heroic war on disease’ according to two leading medical experts.
Doctors receive far too little training – just 20 hours out of five years at medical school – and nurses often ‘do not know what to do’ with the dying.
Dr Katherine Sleeman, a Clinical Lecturer in Palliative Medicine at King’s College London, said it was also important to focus on other needs of the patient beyond just the physical, such as their social needs.
These would include who they cared for or who cared for them - and their psychological needs such as whether they are worried and their spiritual needs at the end of their lives.

Dr Sleeman was speaking at a discussion held in London about how to replace the Liverpool Care Pathway.
The Liverpool Care Pathway (LCP) - guidelines on caring for dying patients - was scrapped two years ago after the Daily Mail highlighted how families witnessed their loved ones being being hastened to their deaths after they were denied food and water.

An independent inquiry said if led to ‘uncaring, rushed and ignorant’ treatment of the most vulnerable patients.
The National Institute for Health and Care Excellence (NICE) has now published draft guidelines on care of the dying.
But Dr Sleeman said one of the reasons she is convinced that it was the right thing to get rid of the LCP was because nurses told her ‘they did not know what to do’ to look after the dying without it.
Good care for the dying is as simple as staying with a patient and allowing them to drink a cup of tea at their pace - rather than leaving a cup of tea in front of them and it being lukewarm or cold
Jonathan Koffman, senior lecturer in palliative care, King's College London
She said: ‘I heard from nurses “it was dreadful that the LCP had gone”. Nurses just didn’t know what to do. That makes me feel it was right to get rid of it.
‘There should be no situation where they don’t know what to do because they haven’t got a piece of paper with them.
'So it suggests it was being used far too much as a crutch rather than a tool to guide palliative care.’
But Dr Sleeman said the new NICE guidelines still do not focus much on ‘patient outcomes’ - how patients feel about their treatment.
Part of the problem is that doctors are too focused on medical interventions – which sometimes do more harm than good.
She said yesterday: ‘The trouble is these things [patient outcomes] are eclipsed by life-saving and all this heroic war on disease stuff that takes up so much of the budgets, education and training for doctors.’
Dr Sleeman said the problem with the LCP was that it focused on processes of care – and did not ask the patient how they were feeling.


She said: ‘So for example ‘Were opioids [painkillers such as morphine] prescribed? Tick. Rather than ‘How was the patients’ pain relieved? Were they comfortable? Were they pain free?’
She added that: ‘I think one of the problems is because people had so little understanding of what good end of life care would be.
I heard from nurses “it was dreadful that the Liverpool Care Pathway had gone”. Nurses just didn’t know what to do. That makes me feel it was right to get rid of it
Dr Katherine Sleeman, Clinical Lecturer in Palliative Medicine
‘It seems weird, doesn’t it, almost something a lay person would understand. My reflection is I would probably have had a better instinct of how to care for a dying person before I went to medical school than after.
‘You get so blinded by the things you have to do, especially as a junior doctor, it can be quite difficult to see the bigger picture, which is essential when you are looking after someone dying.’
It was not acceptable that only one in five trusts train doctors in care for the dying.
She said: ‘It strikes me 100 per cent of doctors are going to have to care for someone who is dying, it strikes me 100 per cent should have some mandatory training on how to look after those people.’
The tick boxes of the Liverpool Care Pathway led to many patients receiving poor care, she said.
She said: ‘As a clinician there were many occasions when I went to see a patient and looked at their Liverpool Care Pathway and saw tick, tick, tick, tick,everything’s above board, and I’d open the curtains and thought ‘Oh. Oh dear. Yes all these boxes are ticked but this patient is in pain.’

Her colleague Jonathan Koffman, a senior lecturer in palliative care at King’s added that good care for the dying was as simple as staying with a patient and allowing them to drink a cup of tea ‘at their pace rather than leaving a cup of tea in front of them and it being lukewarm or cold.’
He said that modern doctors had many more treatments available to them in the 19th century – but as a result they had lost the ability to look after the dying, as they were too busy carrying out interventions and carrying out tests.
Dr Sleeman said good palliative care could save the NHS money. Studies in the US found that cancer patients assigned a palliative care team were less depressed, required fewer drug treatments and lived longer.
Asked what should replace the Liverpol Care Pathway, she said: ‘Doctors on the shop floor need something but really the LCP was too structured, maybe the way it was designed with its tickboxes made it too easy for doctors to treat as a protocol.’
Any replacement should ‘prompt doctors to provide the best care, rather than telling them what to do every two hours.’