Midwifery, Physiotherapy and Palliative Care: a Parable

Published: January 2006

Related Topics: People

Once upon a time, there was a healthy little community. At least, they looked healthy. They had been healthy for quite a long time, so their self-image remained one of good health, even though the reality had changed a little over time. Because they were (in their own opinion) such a healthy community, they were served by a single family physician but no medical specialists. There had once been specialists, but the community was so robustly healthy that they began to seem a bit of an outdated anomaly in the community, and most moved on to other communities where their specialties were more appreciated. Being the family physician to this community was a good job, rewarding but not too demanding: there were sprained ankles to bandage, headaches to prescribe for, annual flu jabs to give, and occasionally the real challenge: surgery for an ingrown toenail.

As time went on, however, things changed, almost imperceptibly at first. As the community aged, the medical needs became more serious.

For example, one family were involved in a car accident, and though no-one was seriously injured, several needed long-term help to get back into good shape. The doctor was puzzled. "Hmmm," she said, "dealing with this kind of thing is really not what I was trained for. I could bandage your ankle, of course, if that would help. And I could probably figure out how to bandage your shoulder if that's painful too."

But the family searched online, and found that other communities had people called "physiotherapists," who were trained for precisely this kind of situation. The doctor was a little nervous about their going to consult a "physiotherapist"--what kind of training did they have, after all?--but what could she say? Maybe it wouldn't do any harm. (It didn't.)

Then one of the community became seriously ill with cancer, and it was clear that the man did not have long to live. "What should we do?" the family asked the doctor. "Well, my training didn't cover end-of-life questions," she admitted. "We assumed that everyone was basically healthy. We haven't had deaths in this community for such a long time. What if I give your father a flu shot? That's something I know about, and maybe it would help."

But the family was not satisfied: "Other people must have had this kind of experience," they said. So they went online, and discovered that other communities had medical personnel specially trained in "palliative care" for the last stages of life. The doctor was dubious about this, but the family seemed to be greatly helped by the palliative care team, and, when their father died, they said to the doctor, "You know, maybe we should have a palliative care team in this community too." But she said, "I don't think we should think so negatively. I would prefer to work at keeping people healthy and alive. Then maybe we won't have to deal with this death business again." The family thought this was a sensible idea and said no more.

The other problem that began in the community was that the young people the doctor had treated since they were small began to grow up, to get married, and to talk about having children of their own. The community was not sure about this. "Look," the older ones said, "we had children twenty years ago. They were a lot of work, and frankly we don't want to go through that again, and we don't recommend that you go through that either. We just need to accept the fact that we are a middle-aged (though healthy) community." And the doctor agreed: "My training didn't cover helping people have babies. That was popular years ago when there weren't as many families as there are now. But having babies these days is seen as a little gauche, not to mention risky. Apart from anything else, it can divert valuable resources that the rest of the community badly needs."

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Midwifery, Physiotherapy and Palliative Care: a Parable

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