When making a recommendation, be sure to carefully acknowledge what the patient and family have told you.
If you listen, but then you recommend something different than what they have requested, it can come across as “not listening” and the conversation may be counterproductive.
It is valuable to make a clear recommendation. Your recommendation may not be accepted immediately — because of lack of information or denial or miracle-based beliefs. But most people appreciate a physician who expresses an informed opinion in a caring way.
You may hear that a family wants “every possible day that medicine can give,” and that their mother would want to be intubated, etc. Acknowledge their goals and share your professional opinion:
“It sounds like you are hoping that by putting your mom on a ventilator, it will prolong her life. However . . . “
You can then say that there is a lot that can be done short of intubation to ensure she is well treated and as comfortable as possible. But remember that you did ask about their goals so your recommendation needs to give evidence that you listened!
Another approach could be to consult the ICU to see if a trial of ICU level care is something that can prolong her life. The ICU can say, no, that won’t actually prolong her life, in which case, you are in sync with families goals and providing them with good information.
Providing information in a sensitive realistic way allows the person to make an informed decision.
- Watch the video below for an example.