From Primary Care to Palliative Care: Dr Lakshmi’s Personal and Professional Palliative Care Journey with ellenor

“We cannot change the outcome, but we can affect the journey”- Ann Richardson

 Dr Lakshmi Subbiah embarked on her professional journey 20 years ago, when she came to the UK to pursue higher training in medicine. She successfully completed her GP training in Medway qualifying as a General Practitioner in 2013 and for the last ten years, she has dedicated herself to the field of medicine, first as a Salaried GP and later as a Partner at a GP practice in Medway. 

Her passion for palliative care medicine has always held a special place in her heart. She lost a close family member to cancer and witnessing the final moments of her loved one’s life inspired her to embark on the route of palliative care medicine, so that she could provide crucial support to families facing similar situations.

What was it like being a GP?

Dr Lakshmi worked in a rural GP surgery, where a significant proportion of her patients were elderly and vulnerable individuals with complex medical needs. Here, she was able to deliver holistic care working closely with the local community. The onset of the pandemic presented a fresh set of challenges, providing her with firsthand experience in dealing with patients requiring end of life care within primary care settings.  It was during this period that she recognised her transferable skills sparking her interest in a career in palliative care.

The Big Transition to Palliative Care.

In 2022, Dr Lakshmi made a momentous decision to temporarily step away from her GP career and resigned from her partnership to purse her passion for a career in palliative care.  She reached out to local hospices, and ellenor hospice offered an opportunity to join their team.

Reflecting on her journey, she recalls “I found it challenging at the beginning. I was so well supported by the team that I was able to settle in very quickly. The multidisciplinary teamwork ensured that patient care was excellent.”

Dr Lakshmi emphasises: “The transition to ellenor has been brilliant and the team has been incredibly supportive. It’s an excellent place to work.”

Working as a GP at a Hospice.

She quickly recognised that she could apply many of the principles of General Practice including holistic care, effective communication, and co-ordinated patient care. The well-established network at ellenor facilitated the smooth delivery of these principles.

Dr Lakshmi as an experienced GP has extensive experience in serving patients and families within the community, and when asked what according to her was the main distinction between GP practice and ellenor, she said ‘the multidisciplinary approach’.  Despite transitioning to a different speciality, she quickly integrated into the ellenor team, thanks to the incredible support she received.

In addition, ellenor has sponsored her to complete the European Certificate in Palliative Care. Furthermore, she can draw on the wealth of experience and expertise through ellenor’s partnerships: namely, with Supportive Care UK (SCUK).

Challenges of Palliative Care

 At ellenor hospice, Dr Lakshmi provides Inpatient ward-based care while also extending her support to families in the community.  “Each patient and their family are unique, with different needs and care requirements”. She works very closely with the patients and families and ensures she takes their wishes and priorities into account when making treatment plans. “I now realise how palliative care not only helps the patient but also provides crucial support to families during their final moments.”

Palliative care is a specialist branch of medicine and Dr Lakshmi has a well-defined Continuing Professional Development Plan (CPD) to ensure that she remains up to date with the latest advancements in this field.  ellenor offers comprehensive support for educational activities, ensuring that all doctors on the team have access to valuable resources.

Dealing with a culturally diverse community

 As an International Medical Graduate from India, Dr Lakshmi possesses a profound understanding of the cultural beliefs held by the diverse local population. She not only understands the perception of hospice and palliative care among patients and their families but also conducts consultations with sensitivity taking into account the cultural beliefs and customs prevalent in the community.

Furthermore, she also acknowledges that her own cultural and spiritual background has enriched her perspective. It has allowed her to approach her role with a broader outlook, viewing patients and palliation through a more informed, inclusive lens.

“My heritage has allowed me to notice the differences and unique aspects among cultures, including what is accepted, or not in each one. This enables me to genuinely understand and empathise with people’s viewpoints. Here at ellenor, we want to make people aware that we’re open to people from diverse cultural backgrounds – and that we can support them throughout their journey.

“Accepting palliative care doesn’t mean you’ve given up on your loved one,” Dr Lakshmi explains but as quoted by Cicely Saunders, a pioneer in hospice care who once said, “We will do all we can to not only help you die peacefully, but also to live until you die.”

Dealing with the emotional challenges of the job

Dr Lakshmi acknowledges that this job can be emotionally challenging for the staff. She feels well supported by the experienced nurses and the entire team but is aware, like the rest of the team, that one has to look after their physical and mental wellbeing while in this job. Dr Lakshmi finds time to reflect on each day and prepares herself for the day ahead.  She is well supported by her family and her pet dog and re-energises herself with regular meditation and walking.

So, with not enough people knowing about palliative care and the wide range of services a local hospice can offer, what is her message to her local community?

“Hospice care is all about making the patient and family experience as caring and loving as possible.  It doesn’t mean that we are giving up on our loved ones, but we make every effort to ensure that patients are comfortable, and that their families are supported.”