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.
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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.
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DNACPR isn’t anyone’s speciality, could that be part of the problem?
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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
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Or the funeral industry, or crematorium staff.
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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.
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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?
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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.
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Replying to @jhartin @RumersRainbow and
Eh? Even - to borrow a phrase - where it's considered clinically futile? Why? What am I missing?
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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
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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.
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