#64 Inpatient Goals of Care with COVID-19

Core IM | Internal Medicine Podcast

Core IM Team

Mental Health, Education, Health & Fitness, Medicine

4.8 • 1K Ratings

🗓️ 22 April 2020

⏱️ 30 minutes

🔗️ Recording | iTunes | RSS

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Summary

What is your approach to goals of care conversations, particularly during COVID-19? How do you navigate some of the new challenges with COVID19? Show notes, transcript and references: https://www.coreimpodcast.com/2020/04/22/goc-on-inpatient-service-during-covid-19/ (https://www.coreimpodcast.com/2020/04/22/goc-on-inpatient-service-during-covid-19/) Time stamps: * 05:54 Laying the groundwork * 08:56 Asking permission, eliciting values and making a recommendation * 15:55 When a patient is dying * 16:42 Sharing the prognosis first * 20:28 Functional status post-CPR * 21:52 Headline statement * 23:40 Virtual and PPE Communication Challenges * 25:28 Separate process from outcome Tag: coronavirus, COVID, CoreIM, Sars-cov-2, medicine floors, wards, advanced care planning Find the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840 Advertising Inquiries: https://redcircle.com/brands Privacy & Opt-Out: https://redcircle.com/privacy

Transcript

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0:00.0	the prep work that's required to set up a thoughtful conversation or even to give a family an update on a given day is requiring a lot of coordination.
0:09.0	We can imagine a whole variety of situations, the patient's not fully cognitively aware. There's language
0:14.4	barriers. The interpreter wasn't available. No family members are in the
0:17.9	hospital. Add in when the patient can't participate. That's Dr. Andy Lawton
0:22.3	a palliative care attending at Dana Harbor Cancer
0:24.9	Institute and Brigham Women's Hospital. He's pointing out just a few of the ways in which
0:30.8	goals of care conversations have changed in the world of COVID-19.
0:35.0	With all of these spots where things can get mixed up,
0:39.7	there's real opportunity for people to not hear information correctly or to, you know, the game of
0:44.2	telephone doesn't get to the sister. So I think the whole virtual world with COVID has
0:50.7	made this more challenging and we have to be extra proactive in setting things up.
0:54.8	Families can't be with their loved ones, patients are terrified of dying alone,
0:59.0	you're often having these conversations in PPE where non-verbals can't be seen.
1:03.8	And on top of these new challenges that COVID has brought
1:07.0	is just the actual challenges of having a goals of care discussion.
1:11.2	These conversations can be quite tricky in and of itself to navigate. of its'
1:14.0	to be quite tricky in and of itself to navigate.
1:15.0	And this communication is a skill like any procedure, right?
1:18.0	It requires that prep work up front.
1:21.0	When you expect the conversation, you have to think, so how do I explain the situation?
1:27.2	How do I summarize the medical condition?
1:30.0	If they ask me that question, how should I answer?
	...

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