Like it or not, as a medical practitioner people are going to take what you say seriously. They will look to you for advice and reassurance during their most vulnerable moments, and will often follow exactly what you say to the letter. This means you have to be careful about what you say, and how.

Advice must be grounded in evidence, explained in understandable terms, with an idea of where to find further information should they forget what you’ve said later on. At home the patient is their own medical practitioner, so just as you’d hand over to a fellow clinician, they must be absolutely clear on the management plan. Your tone should be kind, non-judgemental and should demonstrate that you genuinely care about the person’s question. Instructions should be clear and complete – assume the person receiving the information knows absolutely nothing – and include a safety net for ‘if it gets worse’

(if it doesn’t go away in 3-5 days, see your GP is a fairly good one…)

Reassurance should be given where appropriate. There is always the desire to provide relief for parents and relatives from the anxiety of not knowing what is wrong, especially when a simple ‘It will all be fine‘ would instantly make everyone in the room feel better, however raising expectations in the face of a poor prognosis is going to hurt everyone a lot more down the line, so don’t jump straight in with grand reassurances unless you know they’re warranted.

Having said that, patients and relatives will often worry about things that you wouldn’t think of, so asking them if there is anything that needs explaining is always a good idea. I recently saw a paediatric patient being intubated for refractory seizures. She was completely stable on the ventilator, comfortably asleep, with reassuring vital signs and a promisingly normal CT scan. However her parents, who were NEWSing higher than their baby daughter, understandably interpreted ‘medically induced coma with a machine to help her breathe‘ as a bad sign.

As soon as the anaesthetist asked their concerns, and explained that they could wake her up at any time – this was just to keep her comfortable and free from seizures while they figured out what was going on – they immediately relaxed,

“Oh, well that’s not so bad…”

There was no false reassurance, no optimistic guesses at what the diagnosis might be; just a simple explanation of what was going on, that she wasn’t in pain, that the beeping alarms were just a reminder the infusion was nearly done, made a huge difference to that family’s experience.

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