Our patients need us to have these conversations — we need to let them know we are open to having difficult discussions and that we are not afraid of them. If we are too frightened to talk about these things, imagine how they feel.
Emergency physicians are often reluctant to start these conversations because they cannot be completed or resolved promptly. Like many physicians, we tend to defer them “to others” because
- We don’t want to upset patients whom we don’t know well
- We don’t feel we have the skills to have these conversations
- We’re concerned we may be wrong
- We’re uncomfortable with death and equate it with medical failure
- It is hard to be with someone who is suffering when you can’t fix it
- It makes us face our own mortality
These are complex conversations: consensus about a single clear outcome may not be possible (which is often the case in the Emergency Department.) However it is in everyone’s best interest to start the conversation as early and as openly as possible.
- Watch the video below for an example.