Pre PACES Podcast #23 Difficult Conversations
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Dec 5, 2021 Dr John Platt, a geriatrician and stroke physician with 30+ years NHS experience, shares how to structure sensitive conversations about DNARs, withdrawing feeding, and end-of-life care. Short, practical tips on checking capacity, communicating outcomes clearly, involving teams and families, and documenting decisions. Also a light-hearted quiz on Samuel Johnson for a fun finish.
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Respond Calmly To 'You're Giving Up' Objections
- Do listen and explore why relatives feel you're "giving up" and offer to pause and reconvene if not urgent.
- John Platt suggests explaining DNAR as a specific procedure with low success and proposing another meeting to allow thinking time.
Offer Second Opinions And Involve Senior Colleagues
- Do offer and facilitate a second opinion if families request it and involve more senior clinicians.
- John Platt recommends using the team structure and arranging consultant review to build trust and resolve disputes.
Document Difficult Conversations Meticulously
- Do document DNAR and difficult discussions meticulously, including who you spoke to and time spent.
- John Platt calls the notes (or electronic record) your "greatest friend" in protecting decisions and clarifying events later.