Breaking Bad News, NHS Management & Structure [Case #1]

“You have just started your late shift in Resus and have taken handover. One of the patients is Mr Young a 79 year old man who came in with sudden headache and falling GCS, sadly a CT confirmed a large intracerebral bleed that appears unsurvivable.”

The case has been discussed with neurosurgeons but there is nothing they can offer and they suggested the patient be placed on end of life care. The day team handed over that they have spoken to the family and explained everything and the patient is awaiting a side room and is for end of life care, unfortunately he is still in a normal Resus bay at the moment due to the bed state and his family are with him.

As you walk past the bay the patient’s wife pops her head round the curtain and says:

“Doctor can I talk to you please? When do you think my husband’s operation might be, I’d like to know when he is going to wake up from his coma?”

Questions

Answer one question before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. The first part of teaching will be spent discussing this case:

1. What should you say to Mrs Young?

2. What is your first priority regarding this case now?

3. What can you do beforehand to prepare for your conversation with Mrs Young?

4. What will you plan to say/do during the interview to ensure your conversation is as effective as possible?

5. During your consultation Mrs Young requests that you do everything you can for her husband including resuscitation as she believes “he would want every chance possible”. How would you structure your answer?