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Learning from the experts: my experience in palliative care

Author: Gabby Farrar, 4th Year Medical Student, Leeds University)
05 December 2017

In medical school, we are taught to classify things; systems of the body, specialities, medicine vs. surgery, and so on. Such classifications are very well defined, and it can be seen as out of the ordinary to question these.

Palliative care is different, as I learnt whilst on elective at the Cicely Saunders Institute, King’s College London. It is not simply associated with the physical symptoms (which, according to one consultant, are often the more straightforward part of a patient’s care) but the spiritual demands, the psychosocial aspects, and the affirmation of life, by helping patients to live as actively as possible through to death. It is truly, in a way that I had not previously experienced, holistic.

Throughout my previous teaching experiences on palliative care, I learnt about morphine and alternative opioids, about midazolam for restlessness, and antiemetics.

I spent a day in a hospice, and although this was excellent for learning about pharmacological methods of treatment, my spiritual education was limited to a few minutes in a lecture theatre.

The inconsistent amount of time given to medical students to consider the role of spirituality in healthcare perhaps reflects that spirituality itself is a slightly nebulous term.

What is the relationship between good spiritual care and a good death? Does everyone need spiritual care or is it a reserve of the intensely religious? What actually does spirituality mean?

During my six weeks at the Cicely Saunders Institute, as well as going on ward rounds with doctors, nurses and social workers from the palliative care team, I spent time with the chaplains.

I was particularly interested to discover that they would visit anyone who needed their services, religious or not.

Their role very much depends on what is being asked of them, and varies from emotional counselling and prayer, through to discussing matters pertaining to spirituality.

When the chaplains walked around the children and baby wards (a daily occurrence), they were not only greeting and exchanging pleasantries with the families of sick children, but letting the parents and family members know that they were there, just in case they were needed.

Surprising as the chaplain’s role with the non-religious initially was, it was in keeping with the idea that spirituality is a wider concept than religion (1, 2).

Spirituality is something that every person has (1, 2). It is that thing that makes your life worthwhile and fulfilling: be that through family members, the natural world or even God (1, 2).

Research suggests that spirituality is the second most protective factor against psychological distress at the end of life. Therefore having a chaplain on call, whose primary focus is spiritual (not necessarily religious) health, is intensely helpful (1, 2).

Spending time with the chaplains made me consider the language that should be used when discussing spirituality.

Spirituality is something that is often difficult to know how to approach; an atheist may have a completely different perception in comparison to a devout Christian, for example.

Observing a range of consultations, it became apparent that the way in which the conversation developed depended upon the style of spiritual vocabulary that was employed by the doctor.

This is reflected in the literature, where language has been known as a “symbolic means of interpreting the world” (3).

In her article, Byrne describes language as more than simply the words that leave our mouths, but the intricacies of the way in which these words are articulated (6).  

Communication can also extend to the physical behaviour exhibited when having a difficult conversation: sitting peacefully and openly creates a vastly different experience for the patient than standing with arms folded (3).  

Having observed both the palliative care team and chaplains, I now recognise the need to build up a rapport with a patient before considering spiritual matters.

Sometimes, such an approach can involve beginning at the ‘end’ with the social history of the patient.

This has been surprising for me: at medical school we are taught a certain, set-in-stone route for taking histories which has been drilled into our heads.

Witnessing palliative care professionals undergoing a seamless transition from what a lay person might see as idle chit chat and laughter, to a serious and intense discussion about the person’s final wishes, was illuminating.

The use of anecdotes and entertaining stories (on one occasion this involved sharing tips on making homemade Baileys) came into their own during these conversations and enabled an easier transition to more serious matters.

The amount of palliative care education varies considerably throughout medical schools in the UK (4, 5, 6).

According to surveys, the UK appears to flounder in terms of what we expect our junior doctors to be able to do, and what we are training doctors to do, at the end of life (4, 5, 6).

I feel privileged to have been given the opportunity to spend time at the Cicely Saunders Institute. I hope that I will understand a little more about what to say and what to do when faced with the inevitable ‘bleeps’ in my foundation years.

No matter what, I have learnt a great deal about the care of people at the end of life that will serve me well in my future career as a doctor.


  1. Richardson P. Spirituality, religion and palliative care. Ann Palliat Med 2014;3:150-9
  2. Relationship between spirituality, meaning in life, psychological distress, wish for hastened death, and their influence on quality of life in palliative care patients.
  3. Spirituality: Spirituality in palliative care: what language do we need? Marjory Byrne
  4. Palliative care education for medical students: Differences in course evolution, organisation, evaluation and funding: A survey of all UK medical schools,
  5. Gibbins J, McCoubrie R and Forbes K. Why are newly qualified doctors unprepared to care for patients at the end of life? Med Educ 2011; 45: 389–399.
  6. Bowden J, Dempsey K, Boyd K, et al. Are newly qualified doctors prepared to provide supportive and end-of-life care? A survey of Foundation Year 1 doctors and consultants.
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