Hi guys,
This week I was visiting a patient with a myeloproliverative disorder (bone marrow not producing blood cells). After seeing him a few times I got the impression that he was not aware that he was being refered on to palliative care or what palliative care means. After discussion with the family I learnt that they expect him to be able to ambulate independently again and return back to his normal function. This further confirmed that the patient nor the family know much about the disorder nor the prognosis. What would you guys do in this situation? would you take it upon yourself to explain to the family that the pt may not get better? or would you just let them know that you are working with the patient as much as possible to get to that goal?
Shadi
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Hi Shadi. I think the doctors are the first ones to inform the patient and family about the diagnosis and the prognosis. After that, if they still don't understand what that means you can try to explain it again. It is very important that the patient and family knows the goals of the treatment so they don't create unrealistic expectations and don't get frustrated. I am not sure if I am right, but I still think that is up to the medical team to tell the prognosis and we as a part of the team just help to explain the family/patient if they have any queries. Seems that in this case you will be just be working towards the patient well being. I hope it helps!
Good luck on Wednesday!
What did you do Shadi?
Trudi
Hey shadi.
Caroline is right. It is up to the doctors to initially inform the patient and family of the condition and overall prognosis. Best to speak to the doctors to clarify what they told the patient. If they did give them enough information, then maybe it's worth finding some articles, books, internet sites that the family can be directed to to get a better understanding of the condition before you give your opinion and function prognosis. On top of that, providing treatment to maintain as much function and care as possible
Tough as it is, the pt is required to know what to expect but would be a VERY hard thing to have to break to someone...but it's not completely the physio's role (especially a student's role) but we can help to clarify anything they don't understand.
Hope the situation went well!
fan.
PCR almost over!!
Hi Shadi, as everyone else has said it's the doctors responsibility. In this situation I would talk to the doctors and tell them what the family had said. They may have already told them but they're in a state of denial or alternatively the family don't want to seem negative in front of the patient.
It's a pretty hard situation which is sure to come up in lots of situations. This happens quite often with elderly people who have deteriorated to a point where they are no longer independent. They or their family expect them to go home or the family is pushing for them to be taken in to care while the elderly person has no idea what is going on around. I've had patient ask me similar questions and I always say i'm not sure you'll have to check with your doctor. It works beautifully.
Have a good week, Anna
Hey Shadi....
I agree with Caroline, I think it is the doctors responsibility to inform the patient and family about the condition and prognosis. If the topic comes up following the doctors explanation I would definitely discuss it and help the patient and his/her family understand further. We, as part of the multidisciplinary team, do need to ensure the patient is aware of their situation, but I think our main role is to explain how our treatment fits into their recovery or the maintenance of their condition, not what the condition actually is.
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