Ford Prefect says, “An SEP is something we can’t see, or don’t see, or our brain doesn’t let us see, because we think that it’s somebody else’s problem. That’s what SEP means. Somebody Else’s Problem. The brain just edits it out, it’s like a blind spot.”

The Somebody Else’s Problem field… relies on people’s natural predisposition not to see anything they don’t want to, weren’t expecting, or can’t explain.

From Douglas Adams’ Life, The Universe and Everything 1982

The SEP field generator is an incredible thing, where-ever you shine the beam, like an amazing piece of magic, suddenly the problem disappears and becomes someone else’s problem.

Sound familiar when you think of palliative care patients and their problems?

Other specialities do this to us all of the time, they leave work unfinished or not even attempted. They somehow know that us good-natured folks will make sure that things are sorted.

This isn’t really fair to us, but especially unfair to the patient. Where is the patient in all of this? Certainly not in the centre of attention.

I can’t have a conversation about stopping treatment, so I just keep on continuing the treatment, no matter if it is actually of any benefit to the patient. Said treatment might actually be causing the patient harm, extending their suffering beyond what nature or a higher power would want. So yes it’s really convenient to pass the buck. To let the next person in line sort it out, but it is not good medical practice.

People deserve to have the complete practitioner in attendance, and the complete job done, not just half the job. Not just the easy part, and leave the hard part out.

Is there any wonder that people feel abandoned? In my moment of greatest need, you pushed me away, or put your hand’s up and said “bags not.” I don’t want to get involved, as it has become too uncomfortable to me. Because the practitioners comfort levels are more important that the actual person going through their illness?

That’s not right. How would you feel if it was happening to your sister, your mother, or to you? We are human too, and how would it feel if it was someone you cared about on the receiving end. No, don’t tell me about your problems, then I’ll have to do something about them.

What else could SEP stand for?

Someone else’s – Parent, Patient, Partner,
Seemingly endless pain
Some empathy please

No, it isn’t someone else’s problem, someone else’s business it is everyone’s business. We need to get involved in it otherwise someone will have to wait even longer for the right treatments to happen. Someone will suffer, as will their family.

We cannot allow this to happen to our fellow human beings. How can we change this situation for the better.

How can we raise this issue? How can we get people to change the way they do things?
A futile treatment is of no benefit to the patient, or family. It might actually make matters worse. Not to mention from a health economics point of view, precious resources are used up for no benefit. Does the clinician who is afraid to have the conversation actually benefit either? I don’t think they do. The poor practice just continues on for the the next patient, and the next one. It just keeps on going, with no end in sight.

What can we do to change this mindset? That death and dying is a medical defeat. How arrogant are you to think that you can control Nature? We have had many advances us homo sapiens but we cannot control the hurricane. Harness our abilities to make things better for people, but that can mean that sometimes you have to have the tough conversations. That no treatment that we have will actually keep you alive any longer. It may not prolong your life, but it is likely to prolong your dying and any suffering that is getting worse along the way.

The inability to have these conversations makes these practitioners un-whole, they lack the skills to let go, to call an end to something that just isn’t working. If the first three lines of treatment did not work, the next three are less likely to work. We have made many advances but there is a limit to what we can still do as doctors. It is not for want of trying that we find ourselves in this situation. But there is just a limit to the current state of the art. That cannot be overcome.

Someone’s world is coming to an end, and they are about to lose it all. Is there anything on the other side? I don’t actually know, and I will find out someday, but in the meantime we have to do the best that we can with what we have left. So yes some conversations may be very hard the first time but that does not make them any less necessary.

You want someone with a full skill set, not just half a doctor or nurse. Whole person care needs to be practised by a whole person. You want the complete package looking after you not just a shadow wraith like thing.

Bring it out in words and see what happens.

Practise the conversations, you don’t have to make it up from scratch each and every time.

Please try.

End of Rant.