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C7RKY's profile
John Clarke
John Clarke
John Clarke
@C7RKY

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John Clarke

@C7RKY

Of course views all mine. All without prejudice. Just a regular chap after all. Oh...and RT's may equally imply ridicule as endorsement.

UK
Joined December 2011

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    1. John Clarke‏ @C7RKY Jul 9

      John Clarke Retweeted Aidan Brennan #FBPE

      Sorry - what exactly is being suggested here? 'Shouldn't judge'? Is conducting these conversations not now established to be a lawful requirement? @katemasters67 #HSJPatientSafetyhttps://twitter.com/braemar88/status/1016283271288819714 …

      John Clarke added,

      Aidan Brennan #FBPE @braemar88
      Great talk by @jhartin about talking DNACPR. "We shouldn't judge those who dont/can't carry out these conversations". We shouldn't push anyone to do it, psychological safety is paramount. #HSJPatientSafety #RRS18
      4 replies 2 retweets 1 like
    2. Aidan Brennan #FBPE‏ @braemar88 Jul 9
      Replying to @C7RKY @katemasters67

      If anything it makes them a better one, recognising their limits. A poorly lead discussion can do untold damage. @jhartin

      1 reply 0 retweets 4 likes
    3. John Clarke‏ @C7RKY Jul 9
      Replying to @braemar88 @katemasters67 @jhartin

      With respect, a poorly delivered, (or undelivered), general anaesthetic can do untold damage too - but we don't let people skip over that step with patients because they've had a bad experience previously. It's a skill like any other which must be mastered to be competent, imho.

      1 reply 1 retweet 5 likes
    4. j hartin‏ @jhartin Jul 9
      Replying to @C7RKY @braemar88 @katemasters67

      I don’t think anyone is saying not to do it; what I / we are asking is to support staff properly. You wouldn’t ask the dermatologist to give a GA. However the dermatologist might retrain, and be well supported during the training, in anaesthesia. 🤔

      1 reply 0 retweets 4 likes
    5. Kate Masters‏ @katemasters67 Jul 9
      Replying to @jhartin @C7RKY @braemar88

      DNACPR isn’t anyone’s speciality, could that be part of the problem?

      2 replies 0 retweets 4 likes
    6. John Clarke‏ @C7RKY Jul 9
      Replying to @katemasters67 @jhartin @braemar88

      That's true, but this is not really a change of discipline for me. All treating clinicians must be able to communicate relevant info to pts already. For consent, if nothing else. If discussing death is the problem, then maybe the insurance industry can help - they do it every day

      2 replies 1 retweet 2 likes
    7. Kate Masters‏ @katemasters67 Jul 9
      Replying to @C7RKY @jhartin @braemar88

      Or the funeral industry, or crematorium staff.

      1 reply 1 retweet 2 likes
    8. John Clarke‏ @C7RKY Jul 9
      Replying to @katemasters67 @jhartin @braemar88

      Quite. Certainly not something I'd expect to be beyond the abilities of a trained clinician tbh. And if it is, then the training needs to be reflected upon, imho.

      1 reply 0 retweets 0 likes
    9. Rumer's Rainbow‏ @RumersRainbow Jul 9
      Replying to @C7RKY @katemasters67 and

      Yes – I don't see why discussing DNACPR should be more difficult than other discussions about other treatment options to plump for or not. Eg discussing not to offer surgery to someone who the clinician doesn't feel it would benefit?

      1 reply 1 retweet 6 likes
    10. j hartin‏ @jhartin Jul 9
      Replying to @RumersRainbow @C7RKY and

      That sounds so rational, but the reality is that it is difficult. I have spoken with surgeons who are totally fine with not offering surgery as won’t help (and patient likely to die), but still want patients to have CPR. 🤔

      2 replies 0 retweets 2 likes
      John Clarke‏ @C7RKY Jul 9
      Replying to @jhartin @RumersRainbow and

      Eh? Even - to borrow a phrase - where it's considered clinically futile? Why? What am I missing?

      8:47 AM - 9 Jul 2018
      • 1 Like
      • MonroW
      3 replies 0 retweets 1 like
        1. New conversation
        2. j hartin‏ @jhartin Jul 9
          Replying to @C7RKY @RumersRainbow and

          Psychology / emotion / the things that make us human

          1 reply 0 retweets 2 likes
        3. John Clarke‏ @C7RKY Jul 9
          Replying to @jhartin @RumersRainbow and

          I'd need to better understand that. Considering all the other psychologically challenging / emotional tasks clinicians undertake, which may quite literally include brain surgery, this seems far from exceptional - not to downplay its difficulty for some.

          2 replies 0 retweets 1 like
        4. j hartin‏ @jhartin Jul 9
          Replying to @C7RKY @RumersRainbow and

          I don’t think you will ever ‘get it’

          2 replies 0 retweets 1 like
        5. Kate Masters‏ @katemasters67 Jul 9
          Replying to @jhartin @C7RKY and

          He would, more than most.

          1 reply 0 retweets 1 like
        6. John Clarke‏ @C7RKY Jul 9
          Replying to @katemasters67 @jhartin and

          Ha! Thanks Kate. Although without seeing it several times first hand and talking to those involved, Jill's right - I'll probably never 'get it'. I can't explain it away currently. It makes no sense to me tbh. Real though the phenomenon may be.

          1 reply 1 retweet 2 likes
        7. Kate Masters‏ @katemasters67 Jul 9
          Replying to @C7RKY @jhartin and

          Its hard to get why clinicians find this convo so hard. I don’t really. I’ve had (too) many people screaming murder at me after a missed/poor DNR convo. At that point, none of the reasons cut any ice with bereaved relatives; they just sound like excuses at that point.

          1 reply 1 retweet 0 likes
        8. John Clarke‏ @C7RKY Jul 9
          Replying to @katemasters67 @jhartin and

          As you've said elsewhere - it's a legal requirement. That ought to be reason enough to ensure it happens, badly or otherwise you'd think. But the discussion still appears to be going on this much later, despite the court ruling. I'm genuinely surprised.

          1 reply 1 retweet 2 likes
        9. Kate Masters‏ @katemasters67 Jul 9
          Replying to @C7RKY @jhartin and

          I have been mostly told that it’s because of the fear of litigation because of the legal requirement.

          1 reply 1 retweet 1 like
        10. 6 more replies
        1. New conversation
        2. mark cheetham‏ @MarkCheetham Jul 9
          Replying to @C7RKY @jhartin and

          Well because CPR is the only futile treatment I'm obliged to discuss with a patient

          1 reply 1 retweet 2 likes
        3. Kate Masters‏ @katemasters67 Jul 9
          Replying to @MarkCheetham @C7RKY and

          It’s also the only non-consented treatment we all expect to receive if needed.

          4 replies 0 retweets 2 likes
        4. Elin Roddy (Jones)‏ @elinlowri Jul 9
          Replying to @katemasters67 @MarkCheetham and

          I think some patients don’t expect to receive it - they presume we just wouldn’t do it - which is why having to specifically tell them we won’t offer it can feel difficult.

          2 replies 0 retweets 4 likes
        5. Elin Roddy (Jones)‏ @elinlowri Jul 9
          Replying to @elinlowri @katemasters67 and

          I see it as the last bit of a conversation about prognosis and goals - ‘So in view of what we’ve just discussed, it wouldn’t seem right to be doing CPR at the end of your life - would you agree?’

          2 replies 3 retweets 5 likes
        6. mark cheetham‏ @MarkCheetham Jul 9
          Replying to @elinlowri @katemasters67 and

          That's ok with a competent patient. Sadly many are not and can be difficult to track down relatives at the right time

          2 replies 0 retweets 0 likes
        7. Elin Roddy (Jones)‏ @elinlowri Jul 9
          Replying to @MarkCheetham @katemasters67 and

          I have a similar conversation with relatives - sometimes over the phone if needed - ‘I’m worried about your relative -what are our aims here? what would your relative say if they could talk with us?’ - but yes, this is why it’s great if things are clarified in the ED - or before!

          3 replies 3 retweets 7 likes
        8. mark cheetham‏ @MarkCheetham Jul 9
          Replying to @elinlowri @katemasters67 and

          And then the daughter from London turns up the next day "mum's always been fit, I want you to do everything "..... :(

          2 replies 0 retweets 1 like
        9. Elin Roddy (Jones)‏ @elinlowri Jul 9
          Replying to @MarkCheetham @katemasters67 and

          This is all part of the dialogue, surely? I do now always ask ‘is there anyone else in the family who needs to take part in this decision, do you think they hold a different opinion? Would you like me to talk to them?’ but patient’s best interests paramount obvs.

          1 reply 0 retweets 3 likes
        10. 3 more replies
        1. New conversation
        2. Aidan Brennan #FBPE‏ @braemar88 Jul 9
          Replying to @C7RKY @jhartin and

          Out of interest John what is you backround/experience when it comes to delivering or receiving a treatment escalation planning conversstion or a DNACPR conversation. Id be interested in any insights you have to share be they positive or negative. No obligstion to divulge

          1 reply 0 retweets 0 likes
        3. John Clarke‏ @C7RKY Jul 9
          Replying to @braemar88 @jhartin and

          My personal experience would be of limited relevance on this subject tbh - 1 such example with my father that barely qualifies, as he was the one who instigated the conversation we'd known was coming for 23yrs anyway. Hardly a typical example.

          0 replies 0 retweets 0 likes
        4. End of conversation

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