This is Part II of the difficult discussions we must often have with our patients and/or families. This never gets easier and in reality, should it?
These discussions should be difficult as they are often the catalyst to pursuing advanced care, resuscitation and/or placing a patient on life support. These are some how to's for discussing these topics. This is a continuation of my last article and these are tips that have worked for me.
Some of my patients are homeless and illiterate and drug or alcohol addicted. They need to know that I value them as humans with a medical problem and that I will do everything in my power to help them. I try to use the language and verbage that they give me. If they say "vomicking" or "I fell out" I know what they mean. Conversely, I have patients who are physicians who want to feel in control of their care as much as possible. I explain everything in medicalese and offer as many choices as possible. In either example, my goal is to work WITH the patient for the common goal of the best health attainable.
We should be talking with our patients about the "what ifs" that could happen. What happens if we can't get your breathing turned around? What happens if we put you on a ventilator and then find that we can't get you weaned off? What happens if the chemotherapy doesn't get rid of the cancer?
And...we should be discussing all of the "what ifs" before they happen if at all possible.
For those of us that care for chronically ill patients, we should make a big effort to determine their care wishes and their goals. Do they have a Power of Attorney (POA)?
Do we have their phone number? Are they willing and able to act as a POA? This should be discussed at least on a yearly basis as phone numbers and general situations change.
Many of our patients use several hospitals. Do the hospitals have shared knowledge or a "bridge" for sharing common information?
Do you have access to it and know how to use it? Depending on the hospital system, sometimes you will need to be credentialed at both facilities, sometimes not if there is an already existing information sharing agreement.
Try to establish a relationship with family members. For me, I find that when I make a concerted effort to meet the spouse, child or friend who is close to my patient, I already have a basis for any difficult talk that may arise. Its all about advanced planning if at all possible.
In addition to asking about POAs on a yearly basis, I also ask about advance directives about every six months and more often if the patient is deteriorating. I realize that I have the advantage of caring for chronically ill patients, thus giving me more time to watch and monitor their overall condition.
I also try to be open about end of life care and involve spiritual advisors also if that is appropriate for the situation. Some of my patients are very spiritual and welcome a frank discussion to include the afterlife (or whatever their belief system entails). Others do not. Its all about balance and knowing your patients.
What tips can you all share with us to make these discussions easier?
Do you have a team that handles this like palliative care. Or are you on your own? Does your physician help out or just give vague details?
These discussions should be difficult as they are often the catalyst to pursuing advanced care, resuscitation and/or placing a patient on life support. These are some how to's for discussing these topics. This is a continuation of my last article and these are tips that have worked for me.
Some of my patients are homeless and illiterate and drug or alcohol addicted. They need to know that I value them as humans with a medical problem and that I will do everything in my power to help them. I try to use the language and verbage that they give me. If they say "vomicking" or "I fell out" I know what they mean. Conversely, I have patients who are physicians who want to feel in control of their care as much as possible. I explain everything in medicalese and offer as many choices as possible. In either example, my goal is to work WITH the patient for the common goal of the best health attainable.
We should be talking with our patients about the "what ifs" that could happen. What happens if we can't get your breathing turned around? What happens if we put you on a ventilator and then find that we can't get you weaned off? What happens if the chemotherapy doesn't get rid of the cancer?
And...we should be discussing all of the "what ifs" before they happen if at all possible.
For those of us that care for chronically ill patients, we should make a big effort to determine their care wishes and their goals. Do they have a Power of Attorney (POA)?
Do we have their phone number? Are they willing and able to act as a POA? This should be discussed at least on a yearly basis as phone numbers and general situations change.
Many of our patients use several hospitals. Do the hospitals have shared knowledge or a "bridge" for sharing common information?
Do you have access to it and know how to use it? Depending on the hospital system, sometimes you will need to be credentialed at both facilities, sometimes not if there is an already existing information sharing agreement.
Try to establish a relationship with family members. For me, I find that when I make a concerted effort to meet the spouse, child or friend who is close to my patient, I already have a basis for any difficult talk that may arise. Its all about advanced planning if at all possible.
In addition to asking about POAs on a yearly basis, I also ask about advance directives about every six months and more often if the patient is deteriorating. I realize that I have the advantage of caring for chronically ill patients, thus giving me more time to watch and monitor their overall condition.
I also try to be open about end of life care and involve spiritual advisors also if that is appropriate for the situation. Some of my patients are very spiritual and welcome a frank discussion to include the afterlife (or whatever their belief system entails). Others do not. Its all about balance and knowing your patients.
What tips can you all share with us to make these discussions easier?
Do you have a team that handles this like palliative care. Or are you on your own? Does your physician help out or just give vague details?
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