Unpredictability of emergency red zone is something that I love and hate. There will be days so slow and quiet that you could hear your own breathing and also days where I feel like i am running a full marathon.
During a hectic day at work, the alarm in the red zone went off, and paramedics rushed in with an elderly lady gasping for air. My team and I got to our feet and got to work immediately.
A regular patient that we know of. In her late 90s with Chronic Obstructive Pulmonary Disease, she frequents our ED for mostly breathing issues related to disease progression and mild chest infection. This time around, her situation is really critical.
It was decided that mechanical ventilation was required to save her but with her age and already poor lung condition, very unlikely that she will come out of the ventilation support. One of my colleague has taken the role to communicate with her family.
It was a detailed but brief communication. I heard the last sentence mentioned by my colleague, ‘ Her condition is very critical, do you want us to do everything we can to save your mother ?’
At that very moment I thought to myself, would any family member ever say ‘No, not everything you can. Perhaps 50% of your effort would be plenty for my mother.’
A direct question but with so many gaps in between. What do the family understand about the available options? Do they fully comprehend the possible consequences of each decision?
In most situation, whether or not family members understand fully the situation they will say ‘Yes’ affirmatively. That was the reason they rushed her to the hospital. Irony of the situation, is when I realised that I have asked the same question before.
A palliative physician once told me that a medical consent form will never get you out of a medical related litigation but a good communication skill will prevent one. There is also a study proving that a better patient centred communication effort is able to reduce hospital readmission rate.
The ability of a doctor to provide comfort and trust through their words is the fundamental beginning of a good medical treatment. We were taught the application of medical knowledge but never on how to communication our knowledge. It gets harder when condition is critical, time is short and communication needs to be on point, direct and yet with compassion.
How do we effectively communicate in healthcare?
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