Daily Express, Sabah, Malaysia -- News Headlines

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INDEPENDENT NATIONAL NEWSPAPER OF EAST MALAYSIA Established since 1963 Last Updated: Wednesday, 13 June, 2007 Home DAILY EXPRESS NEWS SEARCH ARCHIVE: Sabah National No doctor shopping, cancer Advance Search Business patients advised 14 May, 2007 SEARCH THE WEB: Sport

Archives Kota Kinabalu: No doctor shopping - Advertising terminally ill cancer patients have been About Us cautioned against moving from one doctor to another in quest of effective treatment. Feedback

WEEKLY SPECIAL Dr Gillian Weighill, 53, a senior Palliative Care Medicine Specialist from Brighton, United Kingdom, found this a big problem here among patients who tend to shop around.

"They have false hope and will keep shopping until someone will give them hope. I think that hope is often false and that makes our job as palliative care physicians more difficult.

"This is because we are trying to help them come to terms with the fact that they are dying and we want to make their dying time peaceful but they are rushing off to Singapore or China to get treatment," she told Daily Express.

According to Dr Weighill, some other patients go to the private sector after treatment in government hospitals "because they don't like what they are told."

From her observation, this problem has to do with collaborative working.

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"If all the doctors work together and tell the same story which is the truth, and if everyone is truthful, then we won't have this problem," she pointed out. Her main expertise is with cancer management in a palliative care setting.

The Palliative Care Medicine Specialist, who has been with a charitable hospice for 18 years, called for more collaboration between the private sector and the public sector.

"There should be more co-operation between government hospitals and private hospitals. If a cancer patient goes to the private hospital, the doctor must ring up the first doctor (in the government hospital) to find out what he (first doctor) has told the patient. Both doctors must discuss what is the best option for the patient."

Likewise, Dr Weighill emphasised the need for improvement in collaborative working between the Queen Elizabeth Hospital's Palliative Care Unit (PCU) and other specialties.

"For example, oncologists need to work very closely with the palliative medicine physicians."

Making a comparison, she said in Britain, doctors readily refer their patients to palliative care services.

"Palliative care is very much part of mainstream medicine now in the UK. We work very much collaboratively with other specialties. But it doesn't seem to be like that here and in some other countries."

While there isn't yet fully a collaboration between the palliative care service and other services, Dr Weighill is confident http://www.dailyexpress.com.my/news.cfm?NewsID=49892 (2 of 6) [6/13/2007 7:18:09 PM] Daily Express, Sabah, Malaysia -- News Headlines

that it is beginning and happening, and will be fully developed in time.

"I think it's because palliative medicine is a relatively new specialty here. It hasn't yet achieved the full status of the other specialties. Maybe doctors in the other specialties are reluctant to refer patients to us (palliative care medicine specialists) partly because they (doctors in other specialties) don't realise what we have to offer."

She also attributed the situation partly to the lack of a training scheme for doctors in palliative care in the Sabah area or in Malaysia generally.

On the need for more palliative care doctors, she recommended that they go abroad for training in this field.

"Once we have a good body of well-trained palliative care physicians in Malaysia, then they can set up training for more doctors."

Dr Weighill's other finding is the problem of communication, not just between the nurses and patients but between professionals as well.

"I think the biggest problem is communication not with the patient but with other professionals. Sometimes when the palliative care team visits the patient under the Home Care Programme, they

don't have enough medical information. For example, the history given is too brief."

Emphasising the importance of honesty with terminally ill patients, she said generally speaking, if a patient asks a question, it's because he or she wants to know the answer.

"Patients have the right to know. So, we http://www.dailyexpress.com.my/news.cfm?NewsID=49892 (3 of 6) [6/13/2007 7:18:09 PM] Daily Express, Sabah, Malaysia -- News Headlines

must always try to answer honestly. And it has been shown that generally, people cope much better with things when everyone is open, frank and honest.

"Obviously, we are not going to be brutally honest. There are always gentle ways of saying things."

On Asian culture which she knew very little about previously, she said one aspect is the very different attitude towards dying.

"It's just different - much less openness here compared with that of patients back home. It's an obstacle to treatment."

However, she observed that religious faith is very much alive here with prayers over dying compared with the situation in Britain.

What if a patient asks how long more he or she can live?

Said Dr Weighill: "No, we don't know the answer. Studies done in Britain have shown that doctors are not very good at predicting.

On the other hand, it shows that nurses doing hands-on care and spending more time with the patient are better at prognostication or judgement compared with doctors."

Dr Weighill, who is on annual leave, is nearing the end of her one-month attachment with the Home Care Programme of the Palliative Care Association of Kota Kinabalu (PCAKK). She is here to further enhance the knowledge and practical skills of doctors, nurses and volunteers, and to help upgrade palliative care services provided by PCAKK.

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Interestingly, she was up for grabs as she had put up an advertisement in the Help Hospices Worldwide E-Bulletin, expressing her intention to do a stint as a volunteer doctor anywhere in the world.

"Immediately, Dr Ranjit Mathew Oommen (Medical Advisor cum Consultant to PCAKK) replied. Come to us, he said. He felt that my coming here would be very useful. I must say a lot of other people around the world also emailed to me. If I were to go to Africa, I would be mainly looking after AIDS patients.

"But I choose to come to Sabah because I have been here before, just as a tourist. That was five years ago. I found Malaysia to be a fascinating country, so I thought I would like to come back."

To Dr Weighill, learning about different cultures is ample reward.

"It makes me re-evaluate everything by working in a different culture. I think I will go back home enriched by the experience here."

While in Sabah, she gave lectures to nurses and lay volunteers involved in palliative care and another one to doctors at the Postgraduate Medical Centre here.

"I emphasised the importance of pain control. That was really the main focus of my talk." In addition, she conducted a workshop on communication skills for the benefit of nurses and volunteers.

Accompanied by PCAKK Nurse Manager, Ellen Yee, a former ICU Sister, Dr Weighill also spends time on home visits.

Saying that the dying stage can be a few months, a few weeks or even the next

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day, she said: "During our home visit, we would make an assessment and find out what is troubling the patient, whether it is physical or psychological symptoms. We then address those symptoms then and there as far as possible.

"Sometimes, we have to go away and come back with medicines or get the patient's relative to come and collect the medicines."

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