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I& #39;ve stammered through my fair share of goals of care conversations in the ED. Yesterday was hard - I& #39;m continually improving. Below is a compiled thread of resources and thoughts to make these go more smoothly not just in the time of #COVID19.
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These conversations are tough. Nowadays they are often over the phone and not in-person. Relay honesty with uncertainty.
@jimfieldsmith @DrAntoniaFS
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@jimfieldsmith @DrAntoniaFS
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Highlight & #39;goals of care& #39;, not treatment options. Patients and family members don& #39;t know what a ventilator/breathing tube/chest compressions means...and especially what happens after. We know, but they likely don& #39;t.
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It& #39;s easy to intubate the patient and get them to the ICU - start the conversation early and take the 15 minutes to understand their goals and relay your recommendations.
To be good at the critical care aspect of EM we must have a strong foundation in palliative care.
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To be good at the critical care aspect of EM we must have a strong foundation in palliative care.
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You are not asking family members if they want to limit care in their loved one. It& #39;s not paternalism-based. Loved ones hear this as & #39;Do YOU want me not to intubate your mom?& #39; Guilt lies on the loved one...which is unfair.
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A few worthwhile podcasts with suggested dialogue - @emcrit
https://emcrit.org/emcrit/end-of-life-care/
https://emcrit.org/emcrit/en... href=" https://emcrit.org/emcrit/semantics-end-of-life-discussions/
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https://emcrit.org/emcrit/end-of-life-care/
6/8">https://emcrit.org/emcrit/se...
April 16th is Advance Care Planning day - talk with your patients and loved ones. Speaking with my grandmother about her goals wasn& #39;t what I had in mind for Easter morning. These conversations are hard, speak with someone afterwards if needed. #weareallhuman
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Any additional thoughts or tips @GeriatricEDNews @WestHealth @KeiO97 @mcsassymd @AGEM_SAEM @LizGoldbergMD @Rick_Pescatore @AmerGeriatrics @MDaware @EmergencyDocs @meganranney @GeriPalBlog @Pallimed @CAPCpalliative @NickJohnsonMD @laxswamy
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