On 1 March, Robert Twycross, known internationally for his clinical work, teaching and writing, and a founding member of the European Association for Palliative Care (EAPC), will celebrate 50 years in palliative care.
To mark the occasion, the EAPC will present a FREE 90-minute webinar on Thursday 25 February 2021, where Dr Twycross will share some of the insights he has acquired over the last five decades. But first, ahead of the webinar, we’ve invited him to share a few key moments of a professional life, dedicated almost entirely to palliative care, that has impacted globally…
I transitioned from general medicine to palliative care in March 1971 when I took up the post of Research Fellow in Therapeutics at St Christopher’s Hospice in London, at the invitation of Cicely Saunders, the Medical Director and the founder of modern hospice and palliative care. In 1976, I moved to Oxford (my alma mater) to be Consultant Physician at Sir Michael Sobell House, a hospice on the campus of one of the University Teaching Hospitals. I remained there until I retired in the early 2000s, since when I have continued writing at home and teaching ‘on request’.
As I look back over half a century, I give thanks for an unbelievably rich and rewarding professional life during which I have been privileged to care for thousands of people with end-stage disease, taught innumerable medical students, doctors and others and, in the early years, conducted research principally into the use of morphine by mouth for cancer pain. Thus my career has comprised a trinity of patient care, education and training, and research.
I first met Cicely Saunders as a medical student in 1963. What she said in her lecture made an indelible impression on me and, after a gestation period of eight years, led to my change of direction in 1971. Since then, the world of palliative care has changed beyond recognition and into myriad shapes and sizes. In addition to the UK, I have been privileged to teach in 44 countries. I was involved in the WHO Comprehensive Cancer Control Programme and, with Professor Vittorio Ventafridda and others, authored its 1980s’ best-seller, Cancer Pain Relief, published in over 20 languages. Writing has been a constant throughout the 50 years with the Palliative Care Formulary being the ‘flagship’ publication since 1998.
Readers may be surprised to learn that in the 1970s there were no morphine tablets – just solutions made up by the local pharmacy. Modified-release morphine tablets were developed in the mid-1970s, some years before immediate-release tablets. Syringe drivers crept in during the 1980s. Our understanding of neuropathic pain has increased steadily over the years, and many new drugs have been added to our drug armamentarium.
Palliative Medicine is now a recognized specialty in an increasing number of countries, and university departments have been established. However, there is much which is still to be done before we are able to deliver ‘palliative care to all who need it’ – in some countries it is still virtually non-existent.
Although I rejoice in the progress made, I am painfully aware that there are many ongoing challenges for the present and next generations. There is still antagonism within the medical profession in some countries. The values of the wider ‘Health Industry’ – competition, rationalism, productivity, efficiency, and profit – are incompatible with compassion and caring, two of the three main pillars of palliative care. Communication skills, certainly among doctors, are still often distressingly poor, and ‘attention to detail’ in pain and symptom management non-existent.
In the webinar, I will share some of the many insights I have acquired over the last five decades and look forward to responding to your questions. If you would like to ask a question, please submit this in advance to firstname.lastname@example.org by Monday 22nd February at the latest, after you have registered for the webinar.
Join Dr Robert Twycross in this free, live webinar, Reflections to mark 50 years in Palliative Care: Pearls of Wisdom? Nuggets of Gold? Or just Base Metal? on Thursday, 25 February at 5 pm to 6.30 pm CET (4 pm to 5.30 pm UK). Please register here https://bit.ly/2OhirmR to secure your place. Places are limited and will be available on a first-come, first-served basis.
More about the author…
Robert Twycross is Emeritus Clinical Reader in Palliative Medicine, University of Oxford, UK. From 1988–2005 he was Head of the WHO Collaborating Centre for Palliative Care. He is co-author of several widely acclaimed textbooks, notably the Palliative Care Formulary (up to 6th edition 2017) and Introducing Palliative Care (6th edition 2021). He has received numerous awards from professional organisations.
Read other posts from Robert Twycross on the EAPC blog: We can’t just stand by: Palliative care and training needs in the community of independent states and in Georgia, Ukraine and the Baltic countries and Sedation at the end of life.