Thread by @colcbrow

#hapc call today, 6 new consults:
Avg pt age= 84
Avg # serious dx= 4
Most common dx: ES CHF, no tx option; ES Ca, no tx option; ES COPD, no tx option
Reason for consult: "Need you to talk about goals and EOL"

Me: So, have you started the convo?
Avg response: "Umm, not really"
1/

#medtwitter It's not easy to discuss late stage dx & end of life issues, but it's crucial. Patients & families deserve clear, honest, empathic info. We all need to know how to *at least* start the conversation. #PalliativeCare teams can help coach, or look for other resources
2/

And certainly at a tertiary care or teaching hospital, this should be hard-wired into the training. Make basic communication a required skill, like diagnosing PNA, placing a line, or running a code. #MedEd- we can, and must do better for our learners & our patients.
3/

In the meantime- some resources:
@CAPCpalliative
@AAHPM
@vitaltalk
@AriadneLabs Serious Illness Conversation Guide (ariadnelabs.org)
"Fast Facts & Concepts" from PC NOW (mypcnow.org)
4/

Or read @RanaAwdish "In Shock"; Paul Kalanithi "When Breath Becomes Air"; @Atul_Gawande "Being Mortal"; @IraByock "The Four Things That Matter Most"; @bjmillermd & @shoshanaberger "A Beginner's Guide to the End"; @SunitaPuriMD "That Good Night", and so many more
5/

While these conversations can be sad, it is also incredibly rewarding to be truly honest & present with another human. I'm humbled by the emotions & insight that are shared in that sacred space. And at the end of this difficult chat, the most often response:
"Thank You" #hapc 6/6