Palliative care pioneer

Professor Ian Maddocks knew early in his career that he wanted to make a difference. Despite his desire to be a medical missionary, opportunity took him to Papua New Guinea (PNG) as a young doctor, where he practised, lectured and later became Foundation Dean and Professor of Clinical Sciences at the University of Papua New Guinea.

He spent 14 years in PNG, where he raised two of his three children with wife Diana, a psychiatric nurse, and spent six memorable years living in a village near Port Moresby. This “enriching experience” in the village provided him with a unique perspective that would later form his views on palliative care.

“It gave me a sense of the importance of tapping into where people are — trying to listen to what the patient thinks and believes about what’s happening to them and to work with that, as well as with your own ideas, the pathology and the treatments that are necessary. You have to modify and adapt what you can do to the patients’ own understanding and wishes and expectations. That was my lesson from Papua New Guinea”, he explains.

It’s a lesson he has kept in mind during his career in palliative care, in which he has been instrumental in helping shape a discipline that is not just responsive to the needs of patients but is also proactive, adaptable and comprehensive in its care.

Top honours

Professor Maddocks’s passion for palliative care, commitment to patients and dedication to driving change led to his being honoured as the 2013 Senior Australian of the Year.

He remembers feeling “flabbergasted” when given the good news.

“It’s hard to know how you get to that situation. It’s all pretty arbitrary. There are lots of people who deserve to be recognised in different ways so you can’t expect this sort of thing, and when it comes it’s bewildering.”

It was no surprise, however, to the many people who have worked with and been inspired by Professor Maddocks throughout his career, and particularly during his 25 years as a pioneer in palliative care.

Palliative Care Australia (PCA) CEO Dr Yvonne Luxford sent heartfelt congratulations to the doctor, who was the group’s first president when it was established under its former name, the Australian Association for Hospice and Palliative Care.

“Professor Maddocks was integral in developing palliative care practices in this country and establishing Palliative Care Australia”, says Dr Luxford.

“Despite being in his 80s, Ian still continues to contribute to the palliative care sector, still actively caring for terminally ill people in his home town of Adelaide, and supervising postgraduate students. He is also still engaged with PCA as a member of the National Standards Assessment Program Steering Committee and acts as a peer mentor to services engaged in palliative care.

“He is truly inspirational and internationally recognised for his work.”

Treading new ground

Professor Maddocks’s journey towards palliative care has been just as inspiring as his work in the latter part of his career.

Upon returning home from PNG to a medical landscape that had become more specialised in his absence, Professor Maddocks was unsure of which direction his career should take. So the family opted to slowly ease back into Australian life, choosing to live with another family they had grown close to during their PNG experience.

“We decided to defend ourselves against the rigours of Australia by forming a community and coming together, and we set ourselves up in Adelaide as a joint venture”, he recalls.

“That continued for about three and a half years. We had various ideas about trying to live frugally and we didn’t have a car. It was quite interesting to see 13 people ride off on bicycles.”

Professor Maddocks held various positions during this time, including specialist physician at Flinders University and working as a general practitioner at his home practice. But the pull towards doing something meaningful that would make a real difference tugged him in a humanitarian direction.

Inspired by his wife’s antinuclear stance, Professor Maddocks’s interest in the cause grew and he soon became a key leader in both the Medical Association for Prevention of War and the International Physicians for the Prevention of Nuclear War. The international group was awarded the Nobel Peace Prize for its work in 1985 when he was vice-president.

Care for the dying

While Professor Maddocks had already shown the makings of a caring and dedicated doctor — a doer in every sense of the word — it was perhaps the next chapter of his career that had the biggest impact on patients and their families as well as health care in Australia.

“Trying to pick up this idea of making medicine in Australia more sensitive to the needs of the dying seemed to be quite a useful thing to do”, he says, of his desire to become more involved in the field.

As his special interest in care for the dying grew, Professor Maddocks’s valuable contribution to the field became cemented in a number of leadership roles. He was first Chair of Palliative Care at Flinders University, where he pursued a rigorous and innovative teaching and research program, as well as caring for patients. He was elected as the first president of the Australian Association for Hospice and Palliative Care (now known as PCA), and was also the first president of the Australian and New Zealand Society for Palliative Medicine. He has also received numerous awards, including the inaugural Bethlehem Griffiths Medal for research in palliative care.

A real patient focus

For Professor Maddocks, palliative care involves not only symptom and pain management but also addresses the fear, anger and other emotions that patients and their families can often experience as the patient’s health deteriorates.

“You need to look at the real needs of the family, then try to design [a strategy] with them that includes where they should be looked after, how care can be funded and what resources are needed. It also involves working with the nurses, who are the most important people in palliative care”, he explains.

“Palliative care is basically good medicine — you’re just looking after people well.”

He said sometimes patients have an aversion to palliative care because they feel that it’s the end of the line but Professor Maddocks sees things a little differently.

“We are trying to make life worthwhile for them by ensuring that they have comfort in a place that suits them best, which sometimes is the home and sometimes, if they can’t cope, it has to be an aged care facility or a hospital. But you do your best to make that as comfortable and as pleasant as possible.”

While there are some sad realities working with people who are dying, Professor Maddocks says it isn’t all sad.

“It’s also very rewarding in terms of the close relationships that you make quite quickly with a family that you visit, particularly when you visit them every day, which I try to do when somebody is very ill”, he explains.

“It’s a matter of the whole family coming together and you see some really lovely things happening — people learning to be open about discussing death and being able to say goodbye with love. It is often quite inspiring.”

Winding down

Today, the 81-year-old works part-time at Ashwood Private Hospital, in Victoria, seeing patients on the wards, in the clinic and in their homes.

“I do quite a lot of home visiting and that’s a lovely way to do things”, he says. “The trouble today is that there is nobody doing this kind of work. The way I practise palliative care is not being done much. [Patients] are gathered into government-funded palliative care units on the whole and there isn’t a great deal of home visiting being done by doctors. The whole show is becoming a little more bureaucratic than it used to be, which is inevitable in the way we run the world [now].”

Despite a full and admirable career, Professor Maddocks says it’s his “marriage and family” that makes him feel most proud. He has three children, about each of whom he talks with enormous pride, and five grandchildren.

Looking back on his career, Professor Maddocks describes it as having been “quite opportunistic”.

“You pick up what presents to you and, if it seems appropriate, you run with it and see what you can do”, he says. “There’s definitely a thread throughout my life of wanting to do something worthwhile. [Palliative care] attracts you partly because there seems to be a need.

“It might sound as though it’s a fairly focused life but it’s a lot fun.”

As for retirement plans, Professor Maddocks knows the time will eventually come but, for now, he’s still as dedicated to palliative care and his patients as he has always been and doesn’t want to stop doing what he loves just yet.

When life does eventually slow down, he looks forward to finishing his research on the story of the PNG village in which he lived that captured his heart and inspired his approach to medicine and life.