When I see a new pt, there is some info that is important to me.
- The date of admission: Admitted 2w ago vs 2m ago is very telling in itself.
- Where patient lives, with who? : Not only for GOC, but also for pain regimen, this is important.
1/
- The time of diagnosis: Cancer diagnosed 3yrs ago vs 3 wks ago is very telling in itself.
- How many admissions over the last 6 (or 12) months: especially for HF. Sometimes I need the exact date of admission and discharge, so that I know how long patient stayed at home.
2/
With the ICU case,
- the date the key life support (vent/CVVH/ECMO) started or finished.
- the date patient was transferred in/out of the ICU.
Some may not think these matter, but these help me imagine how patient has been doing.
3/
• • •
Missing some Tweet in this thread? You can try to
force a refresh
Yes, you have to start GOC by asking "What did doctors tell you?"
But this question should NOT come right after you introduce yourself.
If I were a patient, I would think "Who are you?"
It won't make a good impression.
1/
First, you have to explain what is palliative care and why you are here.
Then, you have to ask about symptoms. Pain? SOB? nausea?
Then, ask about the patient and family.
- Where do you live?
- With who?
- Any family?
- Where do they live?
- Do they come see you?
2/
Then, ask about pre-admission functional status.
- How strong were you?
- Who cooks for you?
- Do you go to the grocery store for shopping?
- Do you take medications by yourself?
With these info, you should be able to picture who/how he/she was before admission.
3/
In a family meeting, after you explained the situation is worse, I see many doctors ask,
"What would he WANT?"
I think this is a BAD question, although I'm aware it is well-intentioned.
I will tell you why...(thread)
1/
What you should do at this point is exploring goals/values of the patient.
But if you use "want", that q is (automatically) asking about treatment options, not goals/values.
(I want chemo, I want dialysis, etc).
2/
For example, your laptop got broken, and you came to a store to buy a new one.
An attendant comes and explains to you.
"model A is 1.4GHz processor/500GB storage/$1000, model B is 2.9GHz processor/1000GB storage/$1500. Which do you WANT?"