liaising_with_health_professionals

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liaising_with_health_professionals [2020/12/02 20:18]
charles 		liaising_with_health_professionals [2020/12/02 20:21] (current)
charles
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 The GP should have the patient’s notes and therefore be up to date on current medications and so on; but it is wise to have all that information, including bowel movements, current feeding patterns, water intake and passing, state of bed-sores, cognitive ability,reported pain and sleep patterns to hand.  The GP should have the patient’s notes and therefore be up to date on current medications and so on; but it is wise to have all that information, including bowel movements, current feeding patterns, water intake and passing, state of bed-sores, cognitive ability,reported pain and sleep patterns to hand. 
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 In serious cases, two difficult questions are likely to come up. The first is hospitalisation. GPs are increasingly ready to recognise the desire of many patients to die at home. It is therefore important to them to know the patient’s current thinking on this. (Patients can change their minds, especially if pain control is proving difficult.) Now that there is a lot of emphasis on patient-centred medicine, there may be reluctance on the part of the GP to take your word on this; he wants to hear it from the horse’s mouth. Some carers take this amiss. “He doesn’t trust me….” Yes, he does, but he has an obligation to check with the patient if s/he is well/coherent enough.  In serious cases, two difficult questions are likely to come up. The first is hospitalisation. GPs are increasingly ready to recognise the desire of many patients to die at home. It is therefore important to them to know the patient’s current thinking on this. (Patients can change their minds, especially if pain control is proving difficult.) Now that there is a lot of emphasis on patient-centred medicine, there may be reluctance on the part of the GP to take your word on this; he wants to hear it from the horse’s mouth. Some carers take this amiss. “He doesn’t trust me….” Yes, he does, but he has an obligation to check with the patient if s/he is well/coherent enough. 
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 That will not, of course, be an easy conversation in  some cases - and your role can feel very uncomfortable, especially if the patient  is a hassle-minimiser. In extreme cases, they will tell the doctor what you know to be untrue, because they “don’t want to be a nuisance.” And that of course puts the GP in an awkward position: his training tells him to listen to the patient; his common sense tells him to listen to whoever watches most carefully and cares most deeply. Luckily, most experienced GPs are well aware of this tension and have developed their own ways of dealing with it. That will not, of course, be an easy conversation in  some cases - and your role can feel very uncomfortable, especially if the patient  is a hassle-minimiser. In extreme cases, they will tell the doctor what you know to be untrue, because they “don’t want to be a nuisance.” And that of course puts the GP in an awkward position: his training tells him to listen to the patient; his common sense tells him to listen to whoever watches most carefully and cares most deeply. Luckily, most experienced GPs are well aware of this tension and have developed their own ways of dealing with it.
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 The other difficult question that may come up with the GP is the DNR notice - do not resuscitate.  S/he will need to know, sooner or later, whether the patient wants to be resuscitated if the need arises. Modern technology can achieve wonders; the question is whether such wonders are welcome. If the patient has already signed a DNR, then show it to the GP so s/he knows where s/he stands. More awkward is the situation where this has never been discussed with the patient - and we may well now be beyond the point at which such a conversation would be relatively easy. The other difficult question that may come up with the GP is the DNR notice - do not resuscitate.  S/he will need to know, sooner or later, whether the patient wants to be resuscitated if the need arises. Modern technology can achieve wonders; the question is whether such wonders are welcome. If the patient has already signed a DNR, then show it to the GP so s/he knows where s/he stands. More awkward is the situation where this has never been discussed with the patient - and we may well now be beyond the point at which such a conversation would be relatively easy.
 Again, there may be tension between what the patient tells the doctor and what s/he tells you. Hassle-minimisers will say they don’t want to cause a stir by being involved in such a procedure. Sparkier souls will want to keep all possibilities for life available - but may be embarrassed to say so. If in your judgement time permits, it may be wise to let a few days elapse before quietly raising the issue and then letting the GP know the final decision. Again, there may be tension between what the patient tells the doctor and what s/he tells you. Hassle-minimisers will say they don’t want to cause a stir by being involved in such a procedure. Sparkier souls will want to keep all possibilities for life available - but may be embarrassed to say so. If in your judgement time permits, it may be wise to let a few days elapse before quietly raising the issue and then letting the GP know the final decision.