How Family Doctors Can Support Patients In Having A Good Death

Dr. Kimberly Wintemute first learned about palliative care during her final year of medical school when on rotation at the Wellesley Hospital in Toronto. As the HIV/AIDS epidemic raged on, the wards were full of young men dying of the disease. “It was heartbreaking,” says Dr. Wintemute. “These men were dying alone, marginalized by their families for being gay and for having AIDS.” The cruelty of the circumstances moved Dr. Wintemute and made her see the importance of people having the support of loved ones and community—the importance of having a good death.

Dr. Wintemute went on to open a family practice in Toronto, also practising obstetrics and emergency medicine. Her days were full of on-call shifts, overnights and weekend care. Although she recognized the importance of palliative care, there was no room in her schedule to fit it in. Over time, Dr. Wintemute delivered little palliative care and subsequently, felt less confident supporting her patients at the end of their lives.

A key challenge for Dr. Wintemute was that she could not always recall dosages for palliative care drugs. As well, she lacked the connections with the home care professionals to order the equipment needed to administer some of the medications. For example, if a patient needed an infusion, Dr. Wintemute didn’t know how to order the pump to administer it. This prevented her from delivering the quality of care she wanted to provide.

Seeking a refresher on palliative care, Dr. Wintemute took the LEAP™ Core course when it was offered at the annual Family Medicine Forum (FMF). The training was engaging and interactive; it reminded her that she was fully capable of delivering palliative care as a family doctor. The training focused heavily on specific cases—rather than taking an overly didactic approach—which made it practical and relevant to Dr. Wintemute’s needs as a busy physician. She enjoyed the overview of the palliative care approach and how to manage pain and other symptoms. As part of the training, she received the Pallium Palliative Pocketbook, a handy peer-reviewed resource full of practical information on delivering effective palliative care. “I use the handbook all the time,” says Dr. Wintemute. “It enhances my ability to prescribe and administer medication properly.”

One of the key takeaways for Dr. Wintemute was that family doctors are not alone in providing palliative care. She learned she could have telephone consultations with palliative specialists about specific issues. If Dr. Wintemute has a patient with a bowel obstruction who would benefit from medication she’s not used to prescribing, she can consult the palliative care doctor on duty who will explain how to prescribe the medication and what to watch for. This helps Dr. Wintemute support her current patient, as well as future patients who might encounter the same problem. By providing ongoing mentorship, specialists empower family doctors to deliver better palliative care at the primary care level.

In her experience, specialists are happy to guide family doctors. “We need family doctors to take on care and consult with specialists,” says Dr. Wintemute. “That way, their expertise touches more patients.”

LEAP™ Core also strengthened Dr. Wintemute’s connections with other key partners in health care—pharmacists, nurses, nurse practitioners and other professionals. It reminded Dr. Wintemute that it is normal not to know all the answers. When she is stuck, she knows who to ask for support.

“The LEAP™ Core training strengthened me as a generalist,” says Dr. Wintemute. “It allows me to continue treating my patients who could benefit from a palliative care approach instead of transferring them to a specialist.”

Impressed by the two-day LEAP™ Core training, Dr. Wintemute helped organize the one-day LEAP™ Mini course to the physicians and nurse practitioners in her family health team. She also recommends the training to colleagues across the country.

“Family doctors are well-positioned and fully-equipped to provide palliative and end of life care,” says Dr. Wintemute. “LEAP™ Core training inspired me and gave me the confidence to take it on.”

The Learning Essential Approaches to Palliative Care (LEAP™) Core training is a two-day course for health care professionals who care for patients with life-limiting illnesses, but whose primary focus is not palliative care. Certified by the College of Family Physicians of Canada for up to 28 Mainpro+ credits, LEAP™ Core was developed and peer-reviewed by a volunteer, pan-Canadian team of subject matter experts who are committed to promoting the palliative care approach. Participants learn the essential skills and competencies of the palliative care approach while building strong teams and fostering collaboration among providers in different agencies who work together.

For more information on LEAP™ courseware, visit Our Courses page.