Dr David Kenner FRACP, FAChPM
Specialist Palliative Care Service, North
Dr Kenner graduated from the University of Melbourne in 1973 & Internship at Royal Melbourne Hospital 1974.
He went on to complete his Physician Training at Royal Perth & Fremantle Hospitals (1977-1980) and worked in private practice as Consultant Physician, Perth 1982-1992
David then trained in Palliative Medicine Sydney 1992-1993, Palliative Medicine Specialist in Melbourne 1993-2018, working at St Vincent’s Melbourne, The Alfred, Caritas Christi Hospice Kew and Eastern Health (Box Hill, Maroondah Hospitals & Wantirna Health PCU)
Dr Kenner spent over 10 years at Cabrini Prahran Hospital, Australia’s first fully private 22 bed dedicated palliative care unit (1999-2010)
David is now working as a Palliative Medicine Physician at Specialist Palliative Care Service, North Launceston, Tasmania from June 2018 which includes home care services, Calvary St Luke’s & Launceston General Hospital.
David’s experience includes palliative care in cancer, advanced HIV and non-malignant illness.
Palliative Care in the North of Tasmania – Musings of an ex-Mainlander
There are distinct social demographics in Tasmania which impact directly on health and present challenges to the effective delivery of palliative care in advanced disease. Tasmania has an older and ageing population c.f. mainland Australia and residents in this state generally have a higher index of relative socio-economic disadvantage, impacting overall health literacy and often the understanding of palliative care, which may be equated with terminal, or near-terminal care. Many patients are living alone, or their spouse/partner may also have significant illness. Home social supports may be affected by the absence of adult children who are living and working on the mainland. Difficulty accepting that disease may no longer be curable, combined with high expectations of disease modifying anti-cancer and other therapies, means some patients are entering the latter stages of illness relatively unprepared and reluctant to accept palliative care. These factors lead to a vulnerability of the patient population during advanced illness. Further, there are high rates of cigarette smoking and related prevalence of smoking related life limiting disease. An illustrative complex case is presented.
The ongoing role of the general practitioner in home and hospice palliative care service delivery in Launceston has been debated since the closure of Phillip Oakden House in 2007. Some more experienced general practitioners may still feel excluded from caring for their patients in hospital under a changed model. However, many GP’s remain involved with home palliative care delivery, although some less so and occasionally may even be reluctant to opioid prescribe.
Home palliative care in Launceston is delivered by the Specialist Palliative Care Service North (SPCSN), the Community Nursing Service, at times with the assistance of the Community Rapid Response Nursing Service, (work profile comprises 20% palliative care) and most usually, the patient’s own general practitioner. The volunteer component of the SPCSN is well valued and does not suffer some of the constraints seen in some similar services in mainland Australia. The various challenges to providing integrated palliative care service delivery are presented.