Well because CPR is the only futile treatment I'm obliged to discuss with a patient
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Replying to @MarkCheetham @C7RKY and
It’s also the only non-consented treatment we all expect to receive if needed.
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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.
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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?’
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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
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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!
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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 "..... :(
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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.
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Replying to @elinlowri @MarkCheetham and
And usually with the distant family member who comes and tries to make sense of things by taking control, I say ‘if we continue intensive treatment I think your loved one will die anyway, but it will be more prolonged and less peaceful’ - harsh, I know.
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Replying to @elinlowri @MarkCheetham and
Honest, not harsh. At least they get her chance to say goodbye. (A box of tissues might be a good idea tho. )
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Indeed. I'll take a harsh truth over an absent one any time. Being informed is so important. It can also avoid provoking unhelpful thoughts in pts/relatives too. It's easy to underestimate what a damaging effect the 'What else haven't they told me?' niggle can have.
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