Attended my very first family meeting for deteriorating ICU patient

Was meant to post this 2 days ago but got "kidnapped" (voluntarily) by grandparents for boot camp style master classes on internal medicine and imaging interpretations 😂 (yes we're imminently entering exam period 💀). 

Back to this post, I had the amazing opportunity to sit in with an incredible ICU consultant when she was having a family meeting with the pt's husband. I am not at all exaggerating when I say she has set the bar extremely high for what true shared-decision making between the healthcare team and the pt's family can and should look like. I got a real sense that the consultant truly meant it when she said "You know the patient best, certainly much better than me, and I'm asking for your help in determining the best treatment option for your wife moving forward when we take into consideration what she holds most dear in life and what's most important to her in life". 

You know you did a good job when the family member / loved one / next of kin turns to the medical student and says "She's doing everything right, just watch and learn". And this is coming from someone who has already been in similar discussions 5 times. 

Top takeaways from this experience 

- private room

- speaking at a measured and calm pace

- make sure you don't give the imp that you want to rush through convo, that it's just a tick-box job to complete 

- futility conversations can seem harsh → reassure loved ones that you’re not giving up on the pt, rather you believe that even if they were to miraculously survive, their likely QoL was be so poor that they would not be content with the life they have post-ICU 

- GENUINELY LISTEN to the pt’s loved ones → there is no way you know the pt better than their families, how could you, you’ve only met them (likely unconscious) for a couple hours

- ICU is more about QoL than extending life → explain that to pt’s loved ones → ask them what pt’s believe is the important aspects of life → ?independence ?more time w family ?waiting for a child/grandchild/great-grandchild’s birth ?feeling like they’re making a valuable contribution to community ?career…→ best tx options will vary according to how pt ans to above qs 

- repeat plans at end of convo, ask if they want you to write discussion down 

- ask loved ones if they have more questions or concerns, whether they want others in the room w them

- be aware that diff people will react to stress and grief and bad news differently, no one emotion or reaction is more valid than another, be prepared for any and all reaction, but obviously don’t cope w abuse 

- take a nurse or colleague with you

- at end of convo, offer loved ones to stay in room for as long as they want, and they can get in contact if think of other questions or concerns anytime and we will try to get back as soon as possible

- debrief w colleagues if required 💕