Breaking Bad News – Key Points
Communicating bad news isn’t an easy task and it’s especially not easy hearing it and hence why, knowing how to break distressing news is an essential skill to have as a Doctor. Despite the nature of the conversation, if you are able to deliver it well, the person receiving it may feel supported going forward.
1. Ensure You Schedule A Time For This
You will, undoubtedly be very busy on the wards and essentially, you don’t want relatives coming in at the time you have suggested and have them wait around to hear what they may be expecting.
- Let your team know of your schedule
- If there are jobs that your team can help you with, kindly ask them if they can help you
2. Ensure You Have A Quiet Room
Distractions and background noises can make it difficult for everyone. It will prevent the message from being delivered and heard in the most respected manner. Having a quiet room can also make it comfortable for the relatives/patient
- Let the ward staff/colleagues know so that you don’t get interrupted
- Turn off your bleeps and phones
- Organise the room (i.e., the chairs) if you need to
- Ask if they would like anyone else to be present
End Of Life Care (EOLC)
Just like MCA, it is beyond the scope of this page to explain in detail regarding EOLC however, we feel it is necessary to be aware of the basics of this topic as it is an extremely important part of practice as a Doctor in the NHS
End of life care is care of those approaching their end of life. These patient’s will need appropriate symptom management and the hospital palliative care team are always happy to help and offer advice!
As Doctors, we have a duty of care towards our patients and whilst it may be our job to treat patients, it is also our job to know and accept when we have done our best. There are times when we must recognise our limitations as a Doctor and that identifying a dying patient is important for the patient as we don’t want to prolong their suffering, we should ensure comfort during the last days of their life.
Junior doctors are not expected to make decisions regarding commencing End of Life Care however it is essential to know what it is. There are medications that can be prescribed for these patients. They are known as anticipatory medications and each trust has their own guidelines – have a look on your trust’s intranet or microguide.
DNA/CPR
DNA/CPR means Do not attempt cardiopulmonary resuscitation (CPR). In hospital, especially during a pandemic such as COVID 19, it is essential to ascertain DNA/CPR status of some of your patients. This may mean that this discussion should take place with your patients and/or their relatives early on during their admission.
DNA/CPR forms may be signed and put in place for various reasons. It may be the patient’s wishes to not be resuscitated in the event they were to deteriorate to a point where resuscitation is required. Some may have come to a decision after a discussion with their healthcare professional. DNA/CPR is essentially a medical decision that is made by doctors after considering the patient and their co-morbidities.
Having a DNA/CPR form doesn’t mean all active treatment should be halted. It only specifies whether or not CPR is given. All treatment should go ahead.
DNA/CPR forms can only be signed by a registrar and consultant. However, if signed by a registrar, the form is only valid for 48 hours and hence why, it must be countersigned by a consultant at the earliest convenience.
