My research has been on the topic of why oncologists refer or do not refer their patients to palliative care, specialised palliative care. This has roots to do with the number of rejections that I have faced while practising as a palliative care specialist in my city. Despite being aggressively into this field full-time, working as a palliative physician, I wondered why oncologists do not refer or choose to refer only when they are facing some kind of problems with their patients. Finding why this happens has led me to do this research; it’s a qualitative research and I had interviewed around thirteen oncologists in the city of Kolkata. There have been interesting results that I have comprehended and I’m going to share that with all of you.

Could you talk a little more about the specifics of your research?

The title of my research is ‘The reasons for referral or non-referral of patients by oncologists to specialised palliative care.’ While doing my research I could find the background is despite my presence or despite these oncologists knowing that, yes, this is the person, this is the right person who can take care of our patients, who can give pain relief, who can manage their symptoms, I wondered why they were not referring these patients to me. That set out for this whole process.

While analysing my findings I could find that oncologists actually relate palliative care as end of life care. To be sure of the fact that end of life care is an important part of palliative care but it is not the palliative care as we have understood, as we have been taught, as the WHO says. So I needed to understand why they do that, how does it manifest in their daily activities – what do they actually think about it?

So these in depth interviews have brought out interesting facts like they would say they would actually take the lifespan of the patient, like 3-24 weeks, perhaps that is where you really want the patient to get palliative care. It’s a kind of sequential thing that they would do because, ‘This is my domain.’ They’ll say, ‘This is my domain and I would not want any other person to intervene in my treatment process.’ So there are similar other factors, for example, one of my referring oncologists has been having a great relationship with me. He said, ‘How you can say there is a lack of service in the city? We have been doing it since the last 35 years. It is the niche that you have created; it’s a new speciality that you have brought. How can you expect that this new girl or this new person would be able to take care of a patient that I have been looking after since such a long time? Because the patient will never want to switch off the doctor.’ So I wondered why don’t you integrate palliative services with what you are doing? You name it as palliative oncology, you name it as palliative intent or curative intent, why not integrate our services… I shouldn’t be saying ours, it should be always an integrated service meant for the patient, a multidisciplinary approach.

So these are the facts that were really disturbing and I think the patient definitely first, although a diagnosis of a cancer or whatever, first goes to an oncologist from perhaps the other doctor who has tried diagnosing the cancer and that particular interface of the oncologist and the patient it cannot be consciously ignored. We need to work on this particular interface to perhaps make the patient aware of the palliative care services, making the oncologist aware of what is meant by palliative care, what the WHO suggest, the numerous research that have been taking place all throughout the world to establish palliative medicine as a speciality. That is where the importance lies.

Secondly, I also found an interesting fact that physicians, the oncologists, they do not regard palliative medicine as something which has palpable benefits for the patient. When they talk about oncological interventions like chemotherapy or radiotherapy or surgery they would refer these approaches to be something with a meaningful approach. But in palliative care, when they talk about palliative care, it’s not like that.

There are numerous other reasons that I would have loved to tell you but definitely because of the time constraint maybe. But I also found good reasons why they refer – sometimes it is from the patient side. They’ll plead with the oncologist, ‘Sir, please do something about my pain,’ and when their expertise fails they would frantically perhaps search for somebody to relieve the patient of pain. It would get the patient over to somebody else so that they are not being disturbed by this kind of symptoms that are not being managed by themselves.