Contributed by:
Jean Kriz, MD – Emergency Medicine / Palliative Care, OSF Saint Anthony Medical Center
Like most emergency doctors, I was attracted to emergency medicine by the opportunity to save lives and listen to diseases. Emergency medicine, by its very nature, makes me a “jack of all trades” and a specialist in resuscitation and stabilization. Resuscitation and stabilization are what many of us like and do best in the emergency department (ED). Making procedures and interventions that save and prolong lives gives us our greatest satisfaction.
During the first years of my career, it was my goal … for all patients. I was not wondering if it was the right thing to do for everyone, whatever their age, their diseases or their prognosis. I thought it was my work to “do everything” to save and prolong lives in an emergency and let the rest be adjusted in the USI.
“We have to do better!”
In recent years, my feeling about this has changed. Several things have led to this:
- The death of my two parents
- An 89 -year -old patient with the emergency who told his family “I don’t want to do this” after several admissions for congestive heart failure
- Learning on an elderly patient with stadium metastatic cancer which has received RCR several times in the last days of his life.
All these reasons made me realize that We have to do better!
Doing better means communication
What is better? Communication, communication, communication! It is a skill that is not always well taught in our medical training. Learning procedures and learning resuscitation and stabilization receive a much higher priority than communication.
Coupled with this is the fact that there is simply not enough time in an occupied ED to establish effective communication. The rapid pace and endless interruptions make it difficult, if not impossible, to quickly forge the type of relationship with a patient and his family to help help in such complex and sensitive decision -making.
These discussions must start in emergency whenever possible because they determine the trajectory of the patient’s hospitalized patients. It is the ideal place to initiate discussions on care objectives before procedures such that intubation has been carried out which are difficult to cancel, not only physically but emotionally.
Other advantages include a previous provision with a shorter stay at the hospital as well as a reduction in readmissions. Once an ED patient becomes a hospital, there is often a delay in consulting palliative care even when the patient is clearly at the end of life, thus denying the opportunity for a significant contribution from the palliative care service.
Provide palliative care in the emergency
At this stage of my emergency medicine career, I realize that We have to do better! Sometimes this better approach is: “Do not do something, stay there!” This is a very hard pill for an emergency doctor to swallow while he flies in the face of what we were trained.
This is why palliative care must be integrated into the emergency. This is why I continue to be an emergency doctor, but I also became a part -time palliative care doctor. My favorite consultations are those that come from the emergency!
Last update: November 5, 2018
