10 Golden rules of palliative care on how to manage a dying person.-you’ll never guess number 4!

Note by the author- this is a humorous article presented in the style of popular buzzfeed and similar articles and I hope brings a little joy to the reader. If any offence is taken, please know that isn’t my intention and I hope you’re able to see the funny side. 

1.    If you prescribe midazolam 5 mg routinely for terminal agitation then you are wrong.

Do say- try to use a dose that works first time.

Don’t say- but 5mg just feels safer. 

2.    Palliating people is not an ok phrase, even in the notes.

Do say-do you mean that you’ve recognised dying despite all best efforts to the contrary?

Don’t say-palliating is just jargon for dying- jargon for dying is ‘DYING’.

3.    Antibiotics are rarely helpful in the last days and hours.

Do say- shall we focus on the important things?

Don’t say- continue whilst the cannulae is in situ. 

4.    Specialist palliative care is most helpful when introduced earlier. Do say- I think we should introduce our colleague so that they can support you whilst we also try what we can.

Don’t say- we still have options so they aren’t ready for palliative care yet. 

5.    Prognosis is never certain, even when it seems so.

Do say- if things continue as they have been then time is likely to be measured in (insert range).

Don’t say- they won’t survive the weekend. 

6.    Informing people that they are dying is not optional.

Do say- how would you like me to talk about your health?

Don’t say- obs are stable -you know who you are. 

7.    Using weak and strong opioids together  is bad pharmacology.

Do say- let’s try and use one opioid-it’ll be easier for you to manage and do everything.

Don’t say- codeine and oxycodone? Why not? (You know why not, don’t pretend otherwise). 

8.    Use specific language, like dying, misunderstanding causes more complaints than any other issue.

Do say- I’m sorry, I believe that you are going to die of your disease.

Don’t say- your condition is deteriorating. 

9.    Tramadol is a bad drug.

Do say- Tramadol Bad.

Don’t say- literally anything else about Tramadol; it’s a naughty drug and needs some very long time out. 

10.                  Dying generally gets better when we de-medicalise the process.

Do say-less is more.

Don’t say- I’ll just continue the statin. Always stop the statin. Always.