APRIL 12 — In Malaysia, Palliative Care was recognised as a medical subspecialty in 2005. In many countries, where similar recognition has been conferred, palliative care is taught in medical and nursing institutions at both undergraduate and postgraduate levels and often as a core curriculum. In Malaysia, this is only available in some universities and institutions of higher learning.
Hospis Malaysia formally started teaching medical undergraduates from Universiti Malaya in 1997 under the Family Medicine programme. By 2019, our educational programme now reaches undergraduate and postgraduate medicine training in four other universities, namely Universiti Pertanian Malaysia, Universiti Teknologi Malaysia, Universiti Pertahanan Malaysia and Perdana University. From time to time, we are also asked to assist with other universities.
The exposure of medical undergraduates to palliative care is very limited compared to their training in areas such internal medicine and surgery. For some students in Malaysia, they would be lucky to have a day’s exposure in palliative care in the whole of their five-year education before they proudly receive their degrees in Medicine.
So, what can be done in a day? At Hospis Malaysia, given a day, there are two facets that we hope to achieve. Education has three components; knowledge, skills and attitude, and changing attitude is the most difficult. If a student is curious enough, he or she hopefully becomes sufficiently engaged to search and acquire new knowledge.
In a seminar setting, we usually start by assessing their understanding of how medicine deals with illness and their perception of palliative care. We would then correct any misconception and provide them with a framework that hopefully would enable to them to appreciate that illness affect patients and families, not just physically but also socially, psychologically and spiritually. A basic assessment framework will also be provided.
For those who are scheduled to spend a day shadowing our clinical team to visit patients at home, this often becomes a highly memorable event, as for most students, this may be the only opportunity to visit patients at home and appreciate their difficulty in coping with their illness.
In the course of their training, medical students become desensitised to being in hospital and may fail to appreciate that for most people, going to the hospital is associated with suffering and not necessarily an occasion to be happy! Home visits allow students to appreciate not just how the illness affects the family but also to see how support structures are put in place to aid them through a palliative care approach.
An appreciation of how people have to live with their illness, how it affects social functioning, the emotions of fear, anxiety, issues around finance and also about questions of why such calamity has fallen on them and much more? For these students, the answers to these questions are not addressed in their medical education and there is a lack of time to address these in a day. Hopefully these questions will serve as a guiding light in their future learning.
In traditional medical teaching, patients are usually depicted as the unfortunate vessels that have been affected by a disease. Hence, patients are rarely referred by name but by the disease they have. So, students may have been asked to “See the breast cancer patient” or “Examine the man who had a heart attack yesterday.”
It is challenging to teach students to appreciate that there is more that they can learn from a patient than the signs and symptoms of a disease. A true palliative care learning experience enables the students to appreciate the life and values of a person, how the illness may have affected their view of life, perhaps examine their priorities, their relationships and what matters most. A patient had remarked “the doctor knows about the disease, but he doesn’t know me”. Thus, teaching students to appreciate the humanity of the people they deal with is important. All to be done in a day...
*Advocating for patients to speak up because they matter, Hospis Malaysia is launching its “Speak Up – Because I Matter” campaign in conjunction with Palliative Care Awareness Month 2019 to improve the quality of life for patients living with life-limiting illnesses. Visit the Hospis Malaysia exhibition at Suria KLCC Concourse, this 11- 13th April 2019 to learn how you can help make palliative care available to all in need.
**This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail.
