Summary
Difficult conversations are always needed in healthcare and are important in order to offer informed choice of what treatments will be of benefit to the patient and are important to manage the expectations of patients, families and clinicians.
But what is currently happening during the coronavirus pandemic in primary care? What should be best practice? Claire, a clinical outreach nurse, explores this in her latest blog.
Content
Imagine...
You are 80 years old. You live independently and have a full social life with friends of similar ages. You have no close family; your friends are your family. You are very much part of the community and enjoy life.
Every winter you get a ‘bad chest’. You visit the GP when this happens and get antibiotics. This is your only health issue.
Being locked down hasn’t been an issue for you. Life is different, but the village you live in has a great support network, you can get shopping delivered, you are connected via the internet to your activity groups – even tai chi on zoom!
You receive a phone call from your GP. They state "...with your chest, it's unlikely that you will survive this virus. So, I need to ask you... do you want to be placed on a ventilator and do you want to be resuscitated?"
They expect an answer while they are on the phone to you.
You have less than 5 minutes to respond.
"Errrrrr, yes… I have lots to live for, please do everything you can" is your reply. You put the phone down and cry. You are scared. What now?
This is a real case that was told to me this morning.
‘Difficult conversations’ are needed. They have always been needed. Whether that be in primary care or secondary care, these conversations are important. It is important to find out what patients and families wishes are, important to offer informed choice of what treatments will be of benefit and important to manage expectations from both, patient, families and clinicians.
Much has been written on how to have these conversations, when to have these conversations and by whom – this advice has been written in a non-pandemic time where people have the time, have up to date, clear information that patients and families can discuss the issues.
Some GPs are using the RESPeCT document, its been slow to adopt and spread, but if completed makes the world of difference. Having an open conversation about dying may feel taboo, but you only get to die once (usually)… you may as well do it well.
Where I work clinically, all patients who are suspected COVID-19, have a treatment escalation form completed as they are admitted. This informs other clinicians what treatment that patient can receive during their admission. If a patient doesn’t have a treatment escalation discussion, patients may experience unnecessary pain, suffering or futile treatment that they didn’t want, but were unable to say.
The treatment escalation form and process we are using has transformed and streamlined our care. We are now able to give the right care to the right patient at the right time. Patients and families are fully informed and are grateful for having the conversation.
But what happens during the pandemic in primary care?
GPs are unable to wait for their patients to turn up to the surgery to have these conversations. Many of their patients are the most vulnerable, in care homes, the homeless and often difficult to reach.
Is a telephone call, out of the blue the best way of having this conversation?
GPs have hundred, if not thousands of patients on their case load, how are they to have meaningful conversations during this pandemic with the most vulnerable?
This blog is not to highlight the bad practice. It is not a time for naming and shaming. We are learning together.
Are you doing things differently? Do you have a solution? Are you a patient and have an idea on how we can do this better?
4 Comments
Recommended Comments
Create an account or sign in to comment
You need to be a member in order to leave a comment
Create an account
Sign up for a new account in our community. It's easy!
Register a new accountSign in
Already have an account? Sign in here.
Sign In Now