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„Doctors Have to Accept that Life Is Limited.”

„Doctors Have to Accept that Life Is Limited.”

Photo: Books lying around in chaos Mister Müller-Busch, the German Association for Palliative Medicine has written once: Even if nothing can be done any more, there is a still lot to do. What does this mean?

Christof Müller-Busch: Even in fatal situations, all possibilities should be used to improve the quality of life, for example by a well-done pain therapy – so that a patient who is terminally ill can still live relatively well. An estimated ten percent of all dying need a special palliative treatment, so in Germany about 80,000 to 100,000 people per year. 26 years ago, the first German palliative care unit was opened in Cologne with five beds. But only now the subject has officially become a part of the medical qualification of doctors. Why did you have to fight for this for so long?

Müller-Busch: The issues of palliative care were touched in other subjects. For a long time, the majority agreed that this was sufficient to cover the subject. As nearly 50 per cent of cancer patients cannot be cured any more at the time of the diagnosis, palliative care plays a major role in oncology, for instance. The problem is that oncology mainly deals with the ways of intervention and is less concerned with the problems of being ill and the suffering person. Palliative care, however, is broader: It focuses primarily on the patient, his physical but also his psychological and social problems. It is not a purely medical subject. This is why it was finally decided that there is a great demand of information, so that palliative medicine was added to the curriculum. The aging society leads to rising numbers of cancer and chronic diseases. Is this an important reason for the increasing recognition of the subject?

Photo: Woman lying in a hospital bed, looking thoughtfully 
If the end comes close, patients
need especially one thing:
honesty; © Picture Disc

Müller-Busch: Absolutely. Palliative medicine attends to all people who are close to death, who suffer from chronic or incurable illnesses. This naturally applies more often to old people. Thus, the demographic trend enlarges the number of the affected. It seems that the new curriculum also meets a request of the students. After all, the German Medical Students’ Association (bvmd) has argued for such a change.

Müller-Busch: The students were indeed very active and applied pressure because they themselves had realised: There is something missing in the medical qualification. I felt exactly the same way in my days as a student. When I received my medical degree 40 years ago I had the impression that I know a lot yet still cannot deal with ill persons. Let me explain: Together with the progress of medicine, the problems are growing. Many ethical questions turn up. It is necessary to think twice: When are medical interventions beneficial and when are they rather a strain on the patient? By now, thank God, many doctors have become more critical than they used to be in the past. They do not do everything anymore, just because it is possible. In the end, it is not only the lifetime that counts - added hours and days – but also the life quality. To treat the pneumonia of a dying patient, so that he lives two weeks longer, can be reasonable but does not have to be. Physicians have to accept that life is limited. So far, there are only a handful of professorships of palliative medicine in Germany. How will it be possible that all of the universities who offer medical studies teach palliative care in future?

Müller-Busch: The faculties throughout Germany will have to breathe life into this subject. As palliative care now is in fact an examination subject of all medical students it has to be taught. At the moment there are six chairs, three more are planned already. As soon as possible there should be a chair at all the universities teaching medicine. Until then, lecturers will fill the gap or professors of related sciences – as oncologists, anaesthetists and pain therapists – will have to take over this field for the moment. Each hospital physician will experience eventually that he cannot always rescue his patients. Then he has to inform a person: „I cannot heal you.“ How to prepare soon-to-be doctors for this moment and everything that follows afterwards?

Müller-Busch: The students have to learn early in time how important it is to develop a good doctor-patient-relationship and to talk with each other about the problems that bother the patient. Physicians must be able to talk about dying and death. It is weird: As a medical student you start with anatomising dead bodies. Yet, so far, dealing with dying and death was hardly given any attention. Dying and terminally ill people are troubled by the most differing thoughts: The one asks what will follow after death, the other would like to sort out his financial situation, a third one would like to solve a problem with his girlfriend before his death. The students learn among others in role plays how to be a partner for the patient. In Cologne, even actors are hired to personate a patient as realistic as possible. Thus, the students practice how to handle emotional situations, for instance a desperate or angry patient. That sounds as if hospital physicians would have to take more time for the individual patient – time is scarce in a hospital‘s dayly routine.

Müller-Busch: It is mainly not a problem of time but of the readiness to deal with the questions and problems that disquiet the patients. The doctors do not have to hold a long conservation but they have to find the right words. Yet many physicians push these questions completely aside and try to avoid such situations out of fear. The doctors have to be made sensitive for those questions and the topic of death should no longer remain a taboo. Studies have shown: A good and honest communication affects the further course of disease positively – fears and pain decrease.

The interview was conducted by Anke Barth


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