Ashburton Surgery

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Advance decision consultations

 

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Advance decision consultations at Ashburton Surgery

During this current coronavirus pandemic, we are aware that some of you may be thinking about your preferences should you become unwell.

We don’t want to add to any anxiety by dwelling on worst case scenarios.  It is our hope that we can relieve some of your worries about the future by knowing that your wishes have been recorded.

Having conversations about your choices and wishes is something we always encourage regardless of this coronavirus outbreak.

Being aware of your wishes really does help us to do our best to ensure that your voice is heard and carefully considered should the need arise.

Perhaps it’s a bit like a pregnant woman making a birth plan with her midwife. She has a chance to put out in advance that she would prefer a home birth, or water birth perhaps, and that she would really be not at all keen on a caesarean section. It doesn’t of course guarantee that her delivery will go that way, but it helps the midwives and doctors understand what’s important to her and try to make that happen.
If a crisis occurs during delivery, then something else may need to happen but the woman and the healthcare team have taken steps beforehand to make sure they understand each other.

Like many,  you may have seen the letter online from the Welsh surgery to their patients which clearly would have caused some distress.

We can be clear that all our patients will be considered for all available treatment options that are appropriate for them, including admission to hospital. These options will be slightly different for each person, depending on their wishes and any underlying illnesses they may have.
Not all patients want to receive intensive hospital treatment if they become unwell. We know, for example, that some people know already that if they became seriously unwell that they wouldn’t want to be put on a ventilator or to be resuscitated, and in these cases it would be sensible for us to know that preference in advance to save any distress to them or their families.

Having advanced care conversations with us is not our way of keeping treatments from you, instead it is a way of you sharing your preferences with us, and recording those wishes to help make the best decisions for each patient when the need arises.

The usual form we use discusses options such as whether going to hospital at all is a thing you would want; whether to have intravenous fluids there if appropriate, or to be artificially fed through a tube, and of course whether to attempt to restart your heart if it should stop.
In the current situation the need for oxygen or ventilation can become an issue.
The hospitals often actually use a pressurised face mask on the wards when people are struggling to breathe. You might want to think about whether that is a thing you would consider as well- there is a link to a video about this at the bottom.

What we want is to understand your unique, individual preferences and ensure they are documented for those who might be deciding on your behalf at Torbay or in the Ambulance Service should you become too unwell to communicate them yourself.
These preferences can be changed at any time if you change your mind.

If you feel you have specific preferences on treatments, we are happy to have that conversation with you. Please contact us to arrange an appointment with you to discuss this further by telephone- let the receptionist know what it is about though so that we can get the right person to call you.  Your regular GP or someone who knows you well would be a good person to have this conversation with.

Don’t be put off thinking we are too busy to deal with these aspects of your care now.  These parts of your care are just as important to us.

For further information about these kinds of conversations please see:

Ward-based face mask ventilation video: https://www.youtube.com/watch?v=RSgwIEziWO0

https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/04/Advanced-care-planning-guidance-and-template-050420.pdf

https://coronavirus.compassionindying.org.uk/making-decisions-about-treatment/

https://www.youtube.com/watch?v=e4h4jmnBL9k&feature=youtu.be

https://www.youtube.com/watch?v=ec2KBCcam3w&feature=youtu.be

https://www.youtube.com/watch?v=LlESjZRiKjo&feature=youtu.be

https://www.youtube.com/watch?v=otUex3ux68s&feature=youtu.be

https://www.youtube.com/watch?v=37VCBXC93I8&feature=youtu.be

https://www.youtube.com/watch?v=mMxFpfEjjmg&feature=youtu.be