“Nothing that I did in medical school prepared me for what I do now, at least in terms of Palliative Medicine.”

So writes Donal Kevin Gordon MD in “What I Do and Why I Do It: A Palliative Perspective”, published in the Journal of Palliative Medicine blog.

Donal Kevin Gordon MD

He describes his work in ways that are both heartening and heart rending – highlighting the emotional challenges and sometimes intense family dynamics he encounters. At the end of the day, he often needs an hour sitting in silence in his living room.

His own personal story is striking as well.

He became a doctor late in life, not entering medical school until the age of 49. Prior to that, he was a professional writer, penning books for major publishers.

Why did he become a doctor? And why palliative medicine?

“Life, in fact, was my only preparation for both,

My mother, dead at 49 of breast cancer; my father, dead at 66, himself of pancreatic cancer; me, my bride, then of only months, then suddenly helping me to raise my 11-year-old brother.

And don’t ask me to tell you about my father’s brothers, lost in their 20s, accidents both;

his mother, dead of cancer in her 40s;

her own mother, killed even younger;

yes, by cancer.”

We come to this work for many different reasons, and even–such as in this case–at different points in our lives.

But as he puts it, the doing of the work is:

“… always good… Always rewarding.

And always, considering with whom I work, in good, very good, company.”

Questions like, who generates evidence? Ninety per cent of scientific medical studies are funded by the pharmaceutical industry.

Does that not automatically exclude studies (and thus evidence) in favour of inexpensive medication?

And not forgetting the recent recommendations that negative results must be published, can we realistically expect implementation of this recommendation?

And finally, in the matter of something as subjective as pain or distress, is it reasonable to rely only on grade 1 evidence?

These are factors that we must consider when evaluating the recent NICE guidelines about management of low back pain.

Read about the controversy in the 2009 autumn issue of British Pain News…

It is dangerous to let any concept – evidence-based medicine included – assume the status of a religion where challenging it invokes wrath and holy wars!