This is a ubiquitous experience amongst emergency physicians.
Too often we see patients with evidently terminal diagnoses come to us in extremis and it seems we are the first to actually tell them that they are dying and there is nothing we can do to stop that.
It is emotionally exhausting.
Too often we see patients with evidently terminal diagnoses come to us in extremis and it seems we are the first to actually tell them that they are dying and there is nothing we can do to stop that.
It is emotionally exhausting.
Reposted from
Clare Eliza
I know that lots and lots of you do a lot of really good work, and I know your funding is precarious. I’ve just had so many bad interactions and uncontrolled deaths in people who seem to have never actually been told they’re dying despite seeing palliative care in the community.
Comments
I think it the ultimate failure if I have not told someone their time is limited.
Too many people talk about possibilities rather than probabilities.
I think she'd had an event like you'd described just before I returned
I'd never realised how often diagnoses such as those were made in EDs, until that event.
I literally told a woman her mom was never going to eat on her own again, much less walk (her actual question) & that she should be seeking hospice care for her—she switched practices.
I don’t know how we fix this.
The distress is always worse when it’s 0300 and the conversation is being had with upset relatives.
I know it's often framed as to not cause distress to patients, but I can't shake the feeling that it's really done to spare the clinician.
The deferral does no one any favours. Inevitably the conversation only gets more difficult as time goes on.
Not a reason to kick the can though.
Helped me hugely to face those discussions with calm when I’m talking to patients
But often you can't book in as the team has other trainees or students attached.
Don't know if it was better in CMT but the programme has never really recovered since the pandemic
Some of each of those specialties do it well, some badly
I agree entirely. And I need be careful not to be too righteous.
As I get older, tho', I see how vital this is. Our specialty does a lot of end of life care. Sometimes I think i just wanna do this stuff...but probably emotionally draining.
It is pretty emotional at times- this last week was one for me- but so rewarding at others.
But it needs to be done. A respiratory CNS, ex ICU, asking at what point her LTOT patients should have a DNACPR- would you intubate them? Then now
Esp palliative chemotherapy.
No one has explained the palliative nature of it, and then we look like the people who are bringing the news and unable to provide any curative treatment.
“I’ve been told there’s another trial” will always haunt me.