Doctors discussing Do Not Resuscitate in front of the patient concerned?

[xtinak]

Would it be normal for a doctor to tell a patient, or tell their family in front of the patient, that they would be a DNR? This happened today with some family members who were quite taken aback. The elderly patient herself obviously found this upsetting. Is this normal? I suppose the patient has a right to know but it seems a bit tactless and unnecessary? Not sure whether or not to be annoyed.

Namechanged as this is completely outing.

I have had CPR. Moreover, the compressions were started while I was still conscious in an attempt to stop my heart from arresting as my heart rate had dropped so low. I can confirm that it is an extremely brutal and traumatic experience and the pain in my chest once I awoke was horrendous.

I was one of the lucky ones. Not only did they manage to bring me back (my heart stopped three times) but I didn’t sustain broken ribs or a punctured lung into the bargain.

The idea of attempting CPR on a frail elderly person is horrific, and I think that this needs to be taken into account as much when the person is so ill that a cardiac arrest is not only possible but likely.

I do agree however that some doctors’ bedside manner leaves a lot to be desired, however I also think that sometimes the blunt approach is the only approach as it leaves no room for confusion, but some people do find that difficult to handle as well.

I have been told very bluntly that my future prognosis is extremely bleak, that if I go back into hospital again I am unlikely to survive, and at one point that I would be ineligible for a heart transplant which is realistically my only hope of a long-term future (some measures have been put in place now to hopefully mitigate that but it’s still a bit of a day-by-day thing.)

These things are never easy to hear, but I would rather hear them directly than some doctor discuss it with my family who would then be left with knowing that which I didn’t and potentially ending up in a situation where they would make decisions on my behalf.

The guidance is that the decision around CPR should be discussed with any patient with capacity to be involved. There is no obligation for family to be involved if the patient chooses not to. Families should be informed and involved where a patient lacks the capacity- but they are not consenting.

I think certainly for us, the issue wasn't that they wouldn't try CPR etc but that it was first mentioned in front of my 3 year old and heavily pregnant me. My df was definitely really upset because he was made to be vulnerable emotionally in front of the people he desperately wanted to protect from his illness. I think he would have much preferred being told in private and then choosing whether or not to tell us.

We had this issue recently with an elderly relative. In my experience the pressure on us as a family to sign the DNAR was huge and relentless. It took place over several days, with several different medical staff. Sometimes it was the very first thing they said when they entered the room.
The language used was unfair, lots of "You must" and "You need to". I was actually told by a nurse that I could be in trouble legally if we didn't get it sorted out!

When you're facing losing a much-loved relative you are already in a highly emotional state, it is grossly unfair to rail-road people into signing the DNAR if they are in any doubt.

My experience made me think that the people who ultimately benefit from this are, in fact, the medical staff. Our GP admitted as much.

My friend is in hospital with advanced cancer. She's near the end, and a DNR has been discussed with her. She is horrified, doesn't understand why it's been mentioned and is completely in denial about her condition. She's also a paramedic, and of all people should know what CPR entails - but no. She has vehemently told the medical team that she wants them to take heroic measures to save her.

The problem, it seems to me, is that discussing a DNACPR brings home the reality of a person's situation and that can be too hard for them and their relatives to hear, no matter how sensitively it is done.

I think it is essential that it is discussed in front of the patient and family. Sadly, when the time comes for this discussion, people can be in a highly charged emotional state.

Resuscitation is brutal, and Doctors should be able to explain this to patients and families in a way that does not frighten them. Nor should they railroad them as one OP said.

When my elderly DM was in hospital she took an unexpected turn for the worst one night and the consultant rang me to ask if we has discussed resucitation with her. We hadn't but after discussion with my 2 siblings we all agreed that DM would not be impressed to find she had been 'brought back.' She had long term heart problems so it was unlikely to be successful in any event. The Dr agreed with us. My DM subsequently picked up and I'm not convinced the DNAR was then discussed with her - although it stood. When she eventually died she slipped away in her sleep anyway.

My DD also had a DNAR and was not for invasive ventilation which was discussed with us and signed by her GP. When she was admitted to hospital seriously ill the registrar (whom we didn't like - but everyone else was lovely) was just focussed on the fact that the DNAR was on a different form to the one they used at that hospital (different county to where we lived) and whilst our DD was in her final hours he was pestering me to agree to his 'new' form. FGS they all said the same thing as far as we were concerned.

Interestingly I was listening to a Dr on local radio this morning talking about a new form they've introduced to ensure everyone with a terminal illness gets to discuss what their Plan B looks like if treatment isn't working any longer. Far better to have the discussion in advance that wait until the end is imminent because then everyone can have a reasoned discussion.

CPR is extremely damaging to frail and elderly people and is rarely successful.

I'm sorry so many have had difficult experiences around this. Thank you for sharing your stories.

I do agree however that some doctors’ bedside manner leaves a lot to be desired, however I also think that sometimes the blunt approach is the only approach as it leaves no room for confusion, but some people do find that difficult to handle as well.

This is my experience with my mother when the GP mentioned it. We called her Dr Death after this conversation, she seemed so eager and pleased to talk about it. It did need to be said though as resuscitation would have been pointless and horrific for someone as frail as mum was.

It's a medical decision, patient and family are often included in the discussion, but ultimately a medical decision and of course if the patient is of sound mind, they will be told.

A doctor waited until we had all gone home to discuss putting a DNR on my dad, he was alone all night knowing that if anything happened they would just leave him to die. They then told us the next day that this would be what was happening, they never asked it it was ok with us.

My consultant said she was putting a DNR on me and asked me to consent.

I said no... still here 😄

Jesus. Just read a bit more of the thread. I think the consultant did put a DNR on me anyway.

Better check that's no longer on my file? Would it be? How do I find s out?

@Shannith speak to PALS and ask for some info or ask for copies of your medical notes.

Shannith no consent is necessary. Having a DNACPR form does not mean you are dying imminently. It doesn’t mean no treatment.

‘we know that the patient was very recently well and active. We are expecting her to recover to her usual self. However her current illness has caused her some temporary confusion and obviously she's a bit weak etc.’
Just because you anticipate the patient will recover fully does not mean that a resuscitation attempt would be worthwhile should their heart stop. They may well recover, but the staff need clear guidance on the best course of action if she doesn’t.
In the kindest possible way, there are a lot of frail elderly people living active lives in their own homes who are one fall or chest infection away from residential care or death.

@Cluckyandconfused Absolutely not disputing that. Totally get why it would need to be put in place. My point was that they didn't handle it sensitively - it left her and family to worry this meant a bad prognosis - and they didn't really include her in the conversation properly because they seemed to misjudge her capacity (other evidence of this as well) . I didn't explain well, sorry, but that's what I was getting at.

Thanks to both who suggested I check my medical notes with PALS. I certainly will.

OP really sorry to hear about how it was handled with your relative and really sorry to hijack your thread - I had t thought about it for a while.

I hope all turns out as well as it can. My situation was different.

I hope everything goes as well as it can.