As part of our efforts to recognise health professionals who have worked in western Victoria, we recently spoke to Dr David Brumley (OAM), a long-time palliative care doctor who recently retired
Dr Brumley grew up on a farm near Cavendish, just south of Grampians/Gariwerd National Park, and went to school in Hamilton. After graduating from high school, he studied Medicine at Melbourne University, inspired in part by an aunt who was a nurse in Hamilton and a dream of being a pathologist. He spent time as a medical intern in Ballarat, where he says he discovered and enjoyed ‘real medicine’ for the first time. He spent more time as a resident at the Royal Children’s Hospital in Melbourne, before being invited to join Ballarat Group Practice as a GP. He worked for 14 years as a GP, before taking up at part-time job in palliative care at Ballarat Hospice Care.
David eventually moved into palliative care full time, driving many thousands of kilometres across western Victoria to provide palliative care in people’s homes, and mentoring many other health professionals in palliative care practices. In 2016 he was recognised for his work with a Medal of the Order of Australia.
These days David lives in Queenscliff, where he moved on his first attempt at retiring. Now, at the age of 74, he seems more confident that his second retirement attempt will be more successful, and is looking forward to spending time in his vegetable garden, listening and playing music, and reading.
What do you enjoy about working as a palliative care doctor?
A few things. During my work in general practice I had this innate understanding that I really didn’t get what looking after dying people was all about, and that impression had come from various sources. One of them was caring for a very elderly senior GP in Ballarat as he was dying. He drove most of the treatment, but he made it very clear what he wanted, so it was easy enough to do. But to be honest, I didn’t understand all the intricacies of it. At that time, we also had a senior visiting palliative care doctor from Perth, Dr Rosalie Shaw, who gave a talk at St John of God in Ballarat and that bowled me over. It was the thing that made me decide to go down the palliative care path.
I went to Perth and worked with Rosalie for six months, dropping down the status pole by becoming a resident in her unit. It was really enjoyable to work in that environment, being well supported and learning a lot. It was mostly learning how to take time with people, how to listen to patients, how to listen to families, how to make group decisions with nursing staff and with families about what kind of care would make sense for the person I was looking after. It might sound silly to say that after, you know, almost a decade in general practice. But most of the general practice that I’d experienced was relatively short-term consultations. There was very little capacity for me to do long consults because the pressure of numbers was high and, of course, the remuneration for doing longer consults was poor. There was no impetus really to sit down unless you really wanted to do it.
So that ended up being my evening’s entertainment: at the end of the day I would go and visit a person who was slated for admission to the hospice service and and see what was going on, see if any symptoms needed to be sorted out, and whether they were appropriate for the service. Then the nurses and I would have a team meeting, which was really exciting, you know, to sit down for an hour or so over lunch talking through with the patients on our books. The home palliative care service was in its infancy at that time as well, and everyone was filled with energy and a wish to make things better. The nurses had the same virus of enthusiasm that I had, so we were all working in the dark together, finding things out and learning things and talking to people who’d been in the game for a while. We gradually formed a very effective home care service, which is still going and is still remarkably good – one of the best home care services in Victoria, I think.
Why do you think home based palliative care is better than hospital care?
The facile answer is that most people who are dying would prefer to die at home. One of the main reasons is that very few people who are dying in hospitals find that their social and psychological care are anything but basic because the nursing staff in most hospitals are not trained in in the skills of end-of-life care. Some of them are now, but 15 to 20 years ago that certainly wasn’t the case.
People want to die on their own turf if they can. Although the research is a bit tricky on that point, often when we’re asking people that question a lot depends on what stage of the illness they’re at. If people are clear that they don’t want any life extending intervention of significance, then usually they’ll want comfort-related care, which is more easily provided at home in an environment that they know, with the people they love and family able to come. It usually is best as long as their comfort is assured and they’ve got attentive staff who can come 24 hours a day to help them if they need it. But there are a lot of ifs there, aren’t there? And certainly, some people change their minds as they get sicker and choose to go to hospital – and I think that’s their right. I don’t think we’re in the game of doing anything but helping people to make the choices that are right for them.
What are one or two things that we could do to improve palliative care in Australia in the future?
The single most important change would be to involve general practice more. I think general practitioners vary in their interest and skills in the palliative care zone. Some of them are still very worried about it and would be happy to hand over all their dying patients. I’m not sure if it’s true, but I’ve heard it said that the average GP sees perhaps two or three dying patients a year, which isn’t enough to develop a skill base that allows them to be comfortable. GPs need maintenance training of some kind. For example, in Geelong there is a monthly general practice palliative care meeting which has been running for decades. We did that for a while in Ballarat, too. That was one way in which we could keep GP skills up to the mark. But, of course, it was always a relatively small number of GPs who came along.
I also think the structure of general practice gets in the way of end-of-life care. If you’re going to look after people in their own homes, there has to be the capacity for the doctor to do that. I’ve been very distressed to find that many GPs simply choose not to do home visits, but I don’t think that’s okay. I know there are many different reasons why they say they won’t: I’m part time, I can’t afford to leave the surgery, I’m frightened about going into people’s homes. I get that to one extent or another, but I still think there has to be some way in which general practitioners can see people in their homes, particularly within bigger practices where it ought to be possible for people to share that load.
If you know a health professional who is retiring and who you’d like acknowledgement of, please feel free to fill our our Acknowledgement of Retired Stakeholders Form, we love talking to professionals about their careers and sharing some of their experiences.