Tell us how you became a doctor Dominic…

I wasn’t quite sure what I wanted to do as a sixth former, I knew I wanted to do something useful and medicine reared its head. I also considered going into the military – I like travel and the languages side so it became apparent I could do both, be a doctor and be in the Army, so I became a medical cadet for the last couple of years at medical school and they contributed to my fees. The contract was to sign up for 6 years in the Army and I stayed for 13 years, and later went into the Navy for 13 years.

I’m not from a medical or military family, in fact my Dad is a linguist, Mum is an English teacher, so I come from a humanities background, and, actually, palliative medicine brings that full circle because it involves meeting people as individuals, being able to spend time talking to them about their own histories, more healing than curing. There’s quite a lot of ethics and philosophy involved in what we come up against in palliative medicine, and in fact I’m studying a Masters in Bioethics and Medical Law.

What are the differences and similarities you’ve seen in healthcare during your travels?

One thing you notice when you travel as a doctor is the health inequalities, for all sorts of reasons, for example in Afghanistan they don’t have a well-established health service and poverty and poor nutrition, too, contribute to the life expectancy being almost half what it is in the UK.

But also, you notice similarities. I’ve been a doctor in wars, I’ve been to the Ebola outbreak and I’ve worked on busy NHS wards, and working in the Hospice here, but actually dying is the same whatever context it’s in. People need the same thing: they need to be affirmed as people; they need their symptoms addressing; they need to be kept comfortable; they need to be reassured that they are valuable and we respect them and see their dignity.

What do you value about working in palliative medicine?

This is the best job I’ve ever had!

Some people can go into it earlier in their careers, but for me, I feel like all my experiences and capabilities and ability to interact with people has led me here and all come together for this job.

It’s the honour and privilege of being around people at this very important time in their lives, it’s the chance to use all of the other things I’ve learnt. A lot of our patients have got things wrong with their chests and from my time as a respiratory consultant, I know how to interact with the hospital to get things sorted on that front, be it a CT scan or a bronchoscopy. I know a lot about infectious diseases from my time in the Army working with tropical diseases, and a lot of our patients have infections.  Also, the life experiences I’ve had, I’m able to relate to the patients, and they are able to relate to me. Having been in the military also sometimes helps with the younger male patients who are floundering a bit and want help with finding a direction and help to come to terms with things.

Does working with people with life limiting illness affect you?

It does affect me caring for someone at the end of their life, I think it affects everyone, it doesn’t get me down though, I’m an optimistic person, I believe in an afterlife so that helps me. On my ward rounds I don’t like to leave the room until the patient has laughed, and if they aren’t capable of laughing, I’ll try to make sure the relative has laughed. Laughter is the best medicine.

It’s a happy place, and there’s less fear from patients and their loved ones than in busy acute hospitals as people have time to listen here and that makes a big difference.

Is working for a charity different to your other experiences?

In some ways it’s different working for a charity, versus working for a unit in the NHS or the military, for example there isn’t anyone I wouldn’t recognise to say hello to here. Really the difference is we are independent, and we aren’t driven by targets and clipboards; good patient care is the outcome we are always aiming for. Of course, we do measure important outcomes to make sure we are serving our community effectively, but we are a very human organisation.

The perception of palliative care in the medical community generally has improved, and in the Health and Care Act, Baroness Finlay added an amendment that commissioners are responsible for providing access to good quality end of life care, which is what St Wilfrid’s is set up to do.

The main thing working here is you’ve got time to build up relationships with your patient, and you’ve got time to do their care properly and thoroughly, and there’s the supportive team element, and the sense of purpose- we know what we are here for – we know what we are doing here- that good outcome for the patients and their relatives.