Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Emergency physicians want you to have the talk about end of life care

Gregory Jasani, MD and Rebecca Rubenstein, MD
Conditions
April 28, 2020
Share
Tweet
Share

Currently, over 60,000 people in the United States are projected to die from coronavirus.  While this is lower than earlier predictions, it is still an appallingly high number.  As two emergency medicine physicians, we have been steeling ourselves for the grim task that lies ahead of us in the coming weeks and months.  We will continue to go to work to try and provide the best care we can to any patient who seeks our care.  We also have a favor to ask of you: Please talk to your loved ones about your goals of care.

The list of “what ifs” for an emergency physician is never-ending.  It’s woven into how we think.  It is essential to how we prepare.  What if this comes in, and I don’t have that?  What if this and that come in at the same time?  What if I don’t have this medication? What if there is a pandemic?  What if we do not have enough ventilators?  Now, we are asking you to prepare and join us in thinking and talking about the “what ifs” that may approach in the coming weeks.  What if I get too sick to make my own medical decisions?  What if I can’t breathe on my own?  What if my heart stops?

The answers to these questions can help shape your goals of care, a narrow subset of a broader process called advanced care planning.  Ideally, this is a proactive and longitudinal conversation with your loved ones and trusted clinicians.  Right now, we do not have that luxury.  “Goals of care” is the term we use to describe the medical interventions a patient wants.  Some patients want every possible option pursued to try and extend their lives.  Others decide that they would not want certain interventions, such as CPR or being placed on a ventilator, regardless of whether it could potentially be life-saving.  In our line of work, we strive to respect a patient’s wishes to the best of our ability.

Unfortunately, we do not always know what a patient wants.  Many patients come to our emergency department too critically ill to tell us what their wishes are.  In those cases, we turn to the family to act as the patient’s surrogate.  Often, the family does not know, as they have never discussed it.  We have seen family members struggle enormously as they try to decide what they think their loved one would want from us.  It is stressful, anxiety-provoking, and emotionally tormenting.  It is simply heart wrenching to watch them wrestle with such an enormous decision.

Having the “what if” discussion with your loved ones can help us align our care with your goals.  It can also alleviate the incredible burden put on a loved one during this time.  Imagine, just for a minute, that your loved one has fallen critically ill, and we are turning to you to ask what he or she would want.  There is not much that will make this easier, but knowing that you are making decisions in line with what he or she wants can hopefully provide some peace of mind during an undoubtedly stressful time.

If you are curious about what types of questions you need to ask, here is a start: What if I can’t breathe for myself? Do I want to be put on a breathing machine?

What if my heart stops?  Do I want doctors to push on my chest, trying to get my heart to beat again?  What if I can’t make decisions for myself?  Who do I want making decisions on my behalf?

We hope you will consider these “what if” questions and discuss them with your family.  Having the conversation now ensures that everyone knows what you would want if you are too ill to tell us yourself.  Regardless of what you decide, we will do everything we can to provide you the best care possible while respecting your wishes.

Gregory Jasani and Rebecca Rubenstein are emergency medicine residents.

Image credit: Shutterstock.com

Prev

It's time for health care professionals to acknowledge our vulnerability and allow others in

April 28, 2020 Kevin 0
…
Next

How to cope during COVID-19

April 29, 2020 Kevin 0
…

Tagged as: COVID, Emergency Medicine, Infectious Disease

Post navigation

< Previous Post
It's time for health care professionals to acknowledge our vulnerability and allow others in
Next Post >
How to cope during COVID-19

ADVERTISEMENT

Related Posts

  • Turn physicians into powerful health care influencers

    Kevin Pho, MD
  • Can the dwindling numbers of primary care physicians explain decreased life expectancy?

    Niran S. Al-Agba, MD
  • Denying payment for emergency care: a physician defends insurers

    Michael Kirsch, MD
  • Solving the problem of non-emergent care in the emergency department

    Michael Kirsch, MD
  • Emergency care coverage denial policies put lives at risk

    Paul Kivela, MD, MBA
  • Violence in the emergency department puts patients and physicians at risk

    Vidor E. Friedman, MD

More in Conditions

  • Why Hollywood’s allergy jokes are dangerous

    Lianne Mandelbaum, PT
  • Coconut oil’s role in Alzheimer’s and depression

    Marc Arginteanu, MD
  • Ancient health secrets for modern life

    Larry Kaskel, MD
  • How the internet broke the doctor-parent trust

    Wendy L. Hunter, MD
  • Mpox isn’t over: A silent epidemic is growing

    Melvin Sanicas, MD
  • How your family system secretly shapes your health

    Su Yeong Kim, PhD
  • Most Popular

  • Past Week

    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • From nurse practitioner to leader in quality improvement [PODCAST]

      The Podcast by KevinMD | Podcast
    • The crushing bureaucracy that’s driving independent physicians to extinction

      Scott Tzorfas, MD | Physician
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • Love, birds, and fries: a story of innocence and connection

      Dr. Damane Zehra | Physician
  • Recent Posts

    • How trust and communication power successful dyad leadership in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why Hollywood’s allergy jokes are dangerous

      Lianne Mandelbaum, PT | Conditions
    • How I learned to love my unique name as a doctor

      Zoran Naumovski, MD | Physician
    • My first week on night float as a medical student

      Amish Jain | Education
    • What Beauty and the Beast taught me about risk

      Jayson Greenberg, MD | Physician
    • Creating safe, authentic group experiences

      Diane W. Shannon, MD, MPH | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • IMGs are the future of U.S. primary care

      Adam Brandon Bondoc, MD | Physician
    • From nurse practitioner to leader in quality improvement [PODCAST]

      The Podcast by KevinMD | Podcast
    • The crushing bureaucracy that’s driving independent physicians to extinction

      Scott Tzorfas, MD | Physician
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why primary care needs better dermatology training

      Alex Siauw | Conditions
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • Love, birds, and fries: a story of innocence and connection

      Dr. Damane Zehra | Physician
  • Recent Posts

    • How trust and communication power successful dyad leadership in health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why Hollywood’s allergy jokes are dangerous

      Lianne Mandelbaum, PT | Conditions
    • How I learned to love my unique name as a doctor

      Zoran Naumovski, MD | Physician
    • My first week on night float as a medical student

      Amish Jain | Education
    • What Beauty and the Beast taught me about risk

      Jayson Greenberg, MD | Physician
    • Creating safe, authentic group experiences

      Diane W. Shannon, MD, MPH | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...