A DAY IN THE LIFE OF…Hospice Physician, Dr Paul Selway

Paul began his career as a mental health nurse prior to medical school and GP training.

Dr Selway

He developed an interest in palliative care as a medical student at St Ann's Hospice. He began working at Wigan and Leigh Hospice in 2012 and completed his Post Graduate Diploma in Palliative Care earlier this year. Paul also works part time as a speciality doctor in palliative care at Wigan Infirmary and spends his spare time paragliding and gardening.

Monday 21st September 2015

8.45am When I arrive at work, I head straight to the daily handover meeting with our multidisciplinary team to discuss any issues that have arisen with patients' overnight or specific requirements for the day ahead.

As palliative care specialists, we are here to manage and treat symptoms such as pain and nausea and to help people adjust to living with a life-limiting illness. Most of our patients go home, once we have their symptoms under control. After discharge a hospice nurse specialist usually visits patients at home.

9.10am The admission meeting follows on from the handover. We look at the waiting list and see if we can admit any new patients today. We admit patients according to a priority system and we work very closely with the community and hospital teams to identify each patient's specific needs. Patients are referred to the Hospice for symptom control, as a transition from hospital to home, due to carer breakdown, psychological distress or for end of life care.

9.15am I call the hospital team to let them know that we have a bed available for their patient. The hospital team do their best to get the patient to the Hospice by 2pm. This can sometimes be difficult to achieve, either due to delays at the hospital or problems with the ambulance service.

9.25am I begin my rounds on the In-Patient Unit. On a weekday, there are usually two doctors on the In-Patient Unit and we each have around seven patients under our care. I see each of my patients for a medical review, wherever possible prioritising any patient who is distressed or in pain. I meet with the patient, and often their family too, to assess their symptoms. We often need to liaise with other professionals (such as physiotherapist, occupational therapist, social worker, GP or oncologist) to co-ordinate different aspects of the patient's care. This sometimes means that it can take well over an hour to see one patient but, wherever possible, I complete my review and document it before moving on to my next patient.

11am I have to re-prioritise the order in which I see patients, as their needs change and as we get their symptoms stable and under control.

12.30pm I grab a bite to eat while the patients are having their lunch (we try not to disturb patients whilst they are eating).

1pm A family member has asked the nurses if they can talk to me about their loved one. It is really important to spend time with family as, by supporting them, they can better support the patient.

We work very closely with the nursing team and they help me to prioritise patient reviews, as they are in more frequent contact with patients and their families and can use their expertise to judge how urgent something is and how quickly the patient needs to be seen.

2pm I meet a new patient on their arrival at the Hospice and spend some time with them to review their history, discuss any issues or concerns and find out what their needs are. I then document the review, develop a care plan for the patient and write their drug chart before handing over the plan to the nursing team.

3.30pm I review a patient for a second time as they are very agitated. Spending time with them is important to help them to settle and also to answer the family's concerns.

4pm I continue my ward round and complete my final patient review.

4.30pm I spend some time in the office dictating discharge letters. These will be typed up by our medical secretaries and sent to the relevant GPs and Specialists.

5pm I talk with the nurse co-ordinator to ask if any patients need seeing before I leave. I pop in to check on the patient who was agitated earlier before going home.

One of the best bits of my job is that I get to spend much more time with each patient than I would in other medical jobs. This gives me the chance to help my patients and their families and loved ones through a very difficult time.

It is incredibly rewarding when we are able to reduce patients' symptoms so that they can go home and get back to living their life as fully as possible.

5.30pm All my patients are settled and I head home.

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