Discover and read the best of Twitter Threads about #endoflife

Most recents (10)

When you want to know why
-women & minorities leave medicine
-why research lacks data to serve needs of anyone not white & male
-why different mortality rates in patients by gender, race, SES

this is why

This is #MedBikini#professionalism” again

Is insidious
but highly effective
-different access

As women, LGBTQ, minorities, disabled enter or advance in medicine, this professor’s public stance will be cited to mislabel having #ethics as “lacking #professionalism…
#medbikini is not one article
=attitude of many physicians
=drives this

We saw this happen with @ayshakhoury and @uche_blackstock and so many others. It especially happens at midcareer to WOC, especially black. Also if Muslim, LGBTQ, disabled, #mentalhealth

Read 52 tweets
@adamcifu - the idea that doctors should not be political is why the entire field of #pediatrics walked out on the rest of #medicine. Children don't have the luxury of "every man for himself" mindset. Also, Muslim patients' or atheist patients' autonomy at #endoflife : political
All of us are trained, in residency, on "political" dollars from #Medicare and much of our #EBM is funded by tax dollars from #NIH and elsewhere. Tax dollars are public money, managed by elected officials, who are put in place and held accountable by the political process.
Then there are seemingly extreme examples, but are they so extreme given how often horrific things happen in history & even uptick of violence in the U.S.? Should doctors opt out of protecting vs this? These camps, if formed, may utilize doctors/nurses…
Read 5 tweets
Throughout December I'm doing a #PalliativeCareAdvent; every day I am going to challenge #misconceptions about #PalliativeCare, #EndOfLife and living with a #LifeLimitingIllness. Some personal, some factual. Do join me!
#Hospice #EOLC #PallMedEd #HPM… Image
Day 1
"#PalliativeCare is only for those who are imminently dying".

Palliative care can help people throughout their illness, from point of diagnosis. It can help people live well, live longer and focus treatment/care around their wishes.
#PalliativeCareAdvent #Misconceptions Image
Day 2
"#PalliativeCare can only occur in the absence of life-prolonging interventions"

It can be given during life-prolonging treatment or in the absence of it. It's about quality of life, symptom control, the person's wishes and preparing for the future. #PalliativeCareAdvent Image
Read 27 tweets
1/ Women in Critical Care:

👍 Just recorded #ISICEM roundtable w @frubulotta @ElisabethWaele @FlaviaSepsis & Dr. Juffermans. 🎥 🍿 on Sept 16th.

Let’s eliminate prejudice based on gender, sexual pref & color. Here is a Baker’s Dozen of Women ICU Leaders!

#heforshe #medtwitter Image
2/ The first woman leader in Critical Care I discussed was Dr. Christina Jones from UK. She is a Biochemist, Nurse, Masters Social Work, PhD in Psychotherapy.

👊Mother of ICU Support Groups & ICU Diaries. As an expert, she shaped our field!

#sccm #esicm #pulmcc #ICUrehap Image
3/ 2nd world leader in Crit Care presented was Dr. Deborah Cook, from McMaster Univ in Canada. Seminal trials in Ulcer Proph, Bioethics, CCCTG trials, and now edifying us about how to provide healing in the dying process through her 3-Wishes Project.
#endoflife #palliativecare Image
Read 8 tweets
Deathbeds. Some thoughts. A thread.

Most of us haven't seen somebody die in real life. We get our inner pictures from TV dramas, cinema screens, media stories. We've had more of those media stories than usual during Covid19. But we haven't been there for real.

Worse: for some of us, our beloved person died and we weren't allowed to be there. We have pictures in our minds of how it might have been, but no way of knowing for sure.

Some of us work in health or social care. We're more likely to have been alongside dying people. But unless we recognise the process, then we may not understand what we are witnessing.

Some experienced workers aren't aware that there are similarities between most deaths.

Read 25 tweets
When I started working on #scabies outbreaks in #carehomes some of my colleagues thought it was a weird, marginal interest. Now with #COVID19 it's changing. Everyone's realising that infection is a big deal in these #EndOfLife settings. Image
#Carehomes for older people are hard to study. Residents often have #dementia, staff are run off their feet, #consent to research is difficult - brilliant colleagues including @MedVetAcarology sorted this…
Life expectancy on entry to a #carehome for older people is typically 8 months - these settings are largely #LastHomes. Everyone needs a plan for what will and won't happen for the common things likely to make them ill or deteriorate. #CPR probably not part of it
Read 13 tweets
#medtwitter and everyone. Pls read this thread. I want ppl to know what those in #nursinghomes and #PALTC med are doing, without the recognition. For every person u save from #COVID inpatient, please know, we're working non-stop to help you, and it's taking its toll. 1/
As early as 3/1 we've shut down visitors, tried to mitigate spread. But we're not the hospital and have less resources. And hospitals rely on us to d/c patients who can't go home. We're taking your pts, knowing full well they may bee carriers of #COVID but testing was not done.2/
Simultaneously we've been forcing the hard conversations, trying to get patients/surrogates to understand the futility in #fullcode status + even hospitalization right now. Meanwhile families have not been allowed to visit in 4 wks +. Despite r efforts, #COVID is in our own 3/
Read 9 tweets

1/ This is one of the most important #covid19 articles you will read

This is about advance care planning

About talking to your doctor- who you know/trust- before you're critically ill about what you want done if you are faced w/ the end of life…
2/ There has been so much discussion about ventilators, ICU bed capacity, ECMO, dialysis etc

We know that outcomes in the elderly w/ #covid19 in the ICU have been abysmal.

Many of these people will end up dying alone on ventilators, if they even get on one.
3/ But is this really what all of these people would even want?

And is the time to discuss this when someone is critically ill in the hospital surrounded by people they've never met?

Primary care doctors NEED to be reaching out to their high risk patients, NOW
Read 9 tweets
She was sleeping when I walked in her room, pushing the curtain aside with my elbow while cleaning my hands with Purell. She looked peaceful. Outside her window, night was falling. 1/8
"Mrs. M***," I lightly shook her left arm, which was folding across her chest. I almost never wake patients up in the hospital because their sleep is often more important than my visit. But this was my last chance. 2/8
She opened her eyes and blinked a few times. With my blue scrubs, white coat, and face mask, I was not easily recognizable. I told her my name. "I'm your oncologist," my smile was hidden by the mask. 3/8
Read 9 tweets
@Marco_Pino_ on work with Vicky Land as part of the #VERDIS and @RealTalk_EOL programme .
Focus on what are known as 'cues' in the comm training community, which are sometimes envisaged as hints the patient is making about a difficult issue, and for which HCPs should be alert
given #ConversationAnalytic approach of staying agnostic abt what a speaker may/may not have been intending, this study looks at times when a pat says something that is potentially hearable as raising something on or forwarding the topic of dying, death, #EndofLife possible cue
systematic places within consultations where possible cues occur
when doc has provided an opportunity to talk abt #EoL related matters
when doc asks qs that do not project EoL related responses, pat can answer more than the q with a move towards implicit then unpacked ref to EoL
Read 8 tweets

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