Day In The Life: Specialty Doctor Lily Chan

Dr Lily Chan works on the hospice inpatient unit (IPU). Her specialty is in palliative care, which involves not only caring for people’s physical symptoms, but also their psychological, social and spiritual needs.

Here she describes a typical day, including how her job involves providing holistic care to people with a wide range of life-shortening illnesses, and how she helps people to get back on their feet and return home after a short stay at the hospice.

9am Handover meeting with the nursing team. They update the medical team on anything that’s happened overnight or issues of concern, which helps us to prioritise the shift. Then, we take a look at new admissions and agree on who’s doing which tasks that day. The average person’s stay is around two weeks, unless their needs are met and medications sorted sooner. This gives the team time to assess and tweak medications, observe patients in case of side-effects and understand their day-to-day needs and symptoms.

10am Ward round to review patients. Following our team briefing, I visit my patients, often with trainee GPs and other medics on placement.

For one gentleman with cancer, it’s his third admission. I’ve met him twice before to help manage his nausea and vomiting. He’s ready to go home now as his medications are working well. There, he’ll be under the care of our community Clinical Nurse Specialists (CNS) team. They’ll stay in touch with me and ask for advice if needed. I can often see the same patients two or three times. In IPU, you treat symptoms to get people as comfortable as possible, so they can go home and spend time with their loved ones while feeling well. If their symptoms change, they can be reassessed or readmitted.

This is really valuable time when I can really talk to people and their loved ones, and offer that all important psychological support. One woman with heart failure is religious, and would like very much for her faith leader to visit her. This is something our Support Team can arrange with their community contacts, so I’ll let them know. She really opened up to me today, whilst her partner was out of the room. It can really help chatting to someone they don’t really know. Talking can be incredibly therapeutic for people, and this spiritual and psychological support is a vital part of our holistic person-centered approach.

I am also caring for a patient who has a young family. She is worried she won’t be there to see her children’s milestones in life. We’ve discussed making a memory box for her children, including cards for key life moments – birthdays, engagements, graduations. She thinks it’s a lovely idea, so I arrange for the Support Team to meet her.

12pm Admin and quick lunch. Paperwork time in the office; updating medical records, liaising with GPs, the CNS team, Support Team, emails, phone calls, etc.

2pm Back on the ward to meet new admissions. I meet a man with COPD (chronic obstructive pulmonary disease), with symptoms of breathlessness, so I arrange for our physiotherapy team to see him. People often think that the hospice only helps people who have cancer, but we also commonly treat people with COPD, heart failure, motor neurone disease, dementia and Parkinson’s. After meeting new patients, I spend time formulating their care plans and document their assessments after review.

4pm Nurse handover. To finish off the day, we have another meeting with the nursing team. They can share updates from their day, and we can let them know of any concerns.

5pm Home time, and I’m on call this evening until 9am tomorrow morning.

10pm Get a phone call from the nights’ nursing staff, asking for advice around medications. I’ll follow up and review them tomorrow, on my ward round.

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