It Starts with a Conversation Damien Doyle, MD, CMD, FAAFP.
14
It Starts with a Conversation Damien Doyle, MD, CMD, FAAFP
-
Upload
erin-kennedy -
Category
Documents
-
view
220 -
download
2
Transcript of It Starts with a Conversation Damien Doyle, MD, CMD, FAAFP.
It Starts with a Conversation
Damien Doyle, MD, CMD, FAAFP
Setting for the Conversation
Quiet, private location. Make sure the patient is as
comfortable as possible. Limit unnecessary interruptions. Avoid multi-tasking. Sit at the patient’s level and
at an appropriate distance.
22
Discussion of Code Status and Life-sustaining Treatments If a patient has or is likely to develop a
condition in the future, then that treatment should be discussed with the patient now.
Despite careful advance planning,emergencies happen – these conversations mayoccur in the ER or ICU.
33
Discussion of Code Status and Life-sustaining Treatments In addition to
physicians, other health care professionals have the knowledge, skills, and experience to discuss CPR and other life-sustaining treatments with patients.
44
Individualize the Conversation
Respect personal, cultural, and religious viewpoints.
Consider who should participate in the conversation.
Consider the individual’s level of understanding and insight.
Consider the individual’s current situation and likely future decisions.
55
What is your role in helping an individual or the authorized decision maker make an informed choice?
66
What is your role in helping someone make an informed choice? Active listening Frame the conversation Communicate the benefits, burdens,
and risks of the intervention Give them the benefit of your
knowledge and experience
77
How do you deal with your own biases?
88
How do you deal with your own biases?
Physician know thyself -- identify your own biases
Understand your personal, religious, or cultural views
Understand the point of view of your specialty (surgery, oncology, and hospice)
99
How do you help authorized decision makers make decisions for their loved one?
1010
How do you help ADM make decisions for their loved one? Determine if the patient has expressed
his or her wishes. Acknowledge the stress of the
situation and the difficulty of the task. Explain the patient’s clinical condition
and prognosis. Explain treatment options and offer
recommendations based on evidence and your clinical judgment.
1111
How do you deal with an individual who does not want to discuss code status or other life-sustaining treatments?
1212
How do you deal with someone who does not want to discuss it? Respect the individual’s right to decline
to discuss it, but perhaps ask more general questions about goals of care rather than discussing code status directly.
Readdress it at a future time. If possible, inform the patient that not
limiting care generally means that medically indicated interventions will be provided.
1313
