Post Conference Learning Points
July 22nd, 2009 at 7:48 pm by LisaThanks to Henry Curtis for an excellently prepared M&M today. Read on for some important learning tips from today’s discussion.
* In cases where the history is limited and the diagnosis is not clear, the patient must be completely disrobed and examined head to toe.
* In elderly, debilitated, or terminally ill patients, engage the patient or proxy in a discussion of goals of care. Treatment or even diagnosis of dangerous conditions may not be compatible with the patient’s or family’s wishes, but often their priorities will not be offered spontaneously and must be elicited.
* Proxies are often reluctant to take responsibility for “reducing” goals of care as they perceive this decision as contributing to the death of their loved one. When appropriate, voice your opinion supporting this type of decision. Example phrases that may be used include “If it were my mother, I would not want further testing and treatment, my priority would be keeping her comfortable,” and “It is completely appropriate to choose to let nature take its course.”
* Proxies often feel as though the decision is their own and lose sight of their role, which is to represent the wishes of the patient. “What do you think your mom would want in this situation if she were able to tell us?”
* As CT scanners evolve and their resolution improves, the benefit of contrast diminishes. A growing body of literature suggests that contrast, especially oral contrast, does not aid in the interpretation of abdominal CT scans. As emergency departments bear the burden of administering oral contrast, emergency medicine may be the stimulus for change for relevant radiology protocols
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