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Importance of Communication in the ICU

Media portrayals of CPR have led to misperceptions in the public about the relative risks and benefits of attempting CPR. In patients with advanced disease, CPR is often unsuccessful and is associated with poor outcomes, including broken ribs and aspiration pneumonia. For many individuals with advanced disease, CPR does not improve the chances of surviving and being discharged from the hospital.

When my father was in the ICU three years ago, I was uninformed about survival chances with CPR. I was thankful for the ICU physician who reached out to me and explained what CPR entailed and that, for my father, CPR would not improve his chances of survival. The physician clearly and patiently outlined care options for my father and was straightforward about the risks and benefits of each option. My father passed away the next day, and I miss him terribly, but I am thankful for the clear communicative style of the ICU physicians and nurses – they helped the dying process be a little less traumatic for my father.

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  • VJ Periyakoil

    Mellissa:
    Thanks for sharing a wonderfully moving and personal anecdote. The biggest issue we are guilty of in medicine is out-of-context extrapolation and thus implementation of ineffective therapies for the wrong candidates. As you point out, CPR is a dramatic example of this. Thanks for highlighting this issue. VJ

  • Vlseno

    So happy that you got to be with your dad without the trauma and drama of something that could only make it worse. We have a social obligation to help families understand decisions they are making, as your doc did. But few do it. Your story helps us go toward better care…and it’s so short, almost everyone can take the time to read it…and hopefully feel a heart string pulled that tells them to be careful and honest with the lives in their care. Thank you again,
    v

  • http://www.wrisources.com/ Vijay

    How rare are such physicians out there? Evolution is yet to throw up a sufficient number of such enlightened species in my part of the world, India. My father-in-law was put on ventilator in spite of a long discussion with the doctor about his advance directives to the contrary (here we are slow to sue). A year ago, I was fortunate to find a surgeon who always had time for a discussion and ended the conversation only if I had no more questions left. I asked a friend in palliative care if we could tweak medical education to make more of them communicate better. She was skeptical. Is the answer in being aggressively proactive in communicating your stake in all life-and-death decisions?      

Can We Talk?
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