Thread by @soumya_goblue

going to summarize this as best I can, I hope some people find this useful (🧵)
1. Establish rapport - I've found in past month that most unvaxxed people with #COVID19 are not inherently bad people - they get bad information from @FoxNews , etc. - don't be dismissive off the bat

https://twitter.com/soumya_goblue/status/1481311805628719114

You want to ask them why they didn't get vaccinated, where they get the info about whatever treatment (ivermectin, Vit C, etc.) and that gets to
2. Establish expectations early - tell them your hospital does not offer those treatments, because they have not been found effective

after extensive scientific evaluation. That you are going to provide the most evidence-based, established medical care after you've treated 3000+, 4000+ #COVID19 patients in your hospital.

3. Code status - You also have to establish expectations on admission here - vanishingly few #COVID19 patients (especially unvaxxed) do well in ICU; if a patient makes clear they want to be DNR/DNI on admission, DON'T let family change that if patient decompensates

And make clear, especially for elderly patients, those with comorbidities, that you will provide all aggressive treatment to prevent them from going into cardiopulmonary arrest, but if that happens, their chance of survival is extremely low. Need to say this on admission

Can revisit it with patient during their clinical course (I had this happen with a patient who wanted to be full code early, but as they declined, pt still in full faculties and decided to be DNR/DNI, and this decision reiterated to family as pt's wishes). But establish early.

4. LAWSUITS - despite all this, families may threaten to sue you. A piece of advice I liked, "they are going to sue you no matter what you do, it is most defensible if you provide good evidence-based medical care" FWIW, in state of #Michigan, the judiciary is liberal leaning...

and while several people have threatened to sue for court order for ivermectin, etc, the courts have thrown it away, saying they are not medical practitioners and will not dictate medical care. This may vary depending on state you live in, but just do what is best medical care

and even if you live in a crazy right wing judiciary, it will eventually be thrown away by a higher level court. Don't bow down to patients' wishes because of threat of lawsuit, that sets dangerous precedent.

Also, some patients have mentioned "Right to Try", not knowing what that means. It doesn't mean doctors have to be forced to try ineffective treatments patients want - it means doctors have "right to try" experimental, Phase II treatments that show promise, but not FDA approved

So don't get scared away by "lawyers" or "lawsuits", just reiterate that you are practicing sound, evidence based medical care; get your risk-management team involved, let them know those are pt's wishes, and you will be protected in the end.

Finally 5. Despite all this, some patients and families will remove their loved one, desat'ing on 15L non-rebreather, from hospital against medical advice. You know that person is going to die. Don't internalize this. You will just mess up your own mental health and your family's

You have done everything you possibly could to help this patient and family, and just know you are not responsible for the decisions they make, even if it's going to hurt them or possibly lead to death. This is hard one, but only way you can survive this pandemic as a HCW [/fin]