Dr Doctor please speak to the family.

In elderly care a lot of bad news tends to get broken. A lot of patients sadly come to the ends of their lives on these wards, mostly because they've just been living for a very long time and have diminished reserves and multiple co-morbidities.

One lady of 95 was admitted with a stroke a couple of weeks ago and managed to acquire an infection of some sort. She was really very unwell and probably coming to the end of her life and it fell to me to talk to the family about possibly going down the palliative care route if she deteriorated further. I had mixed feelings about being the one to do this. On one hand, I probably knew her the best out of my junior doctor colleagues, but then I am the most junior of my junior doctor colleagues. It's a powerful position to be in, with the family looking to you for answers to their questions, and to have the authority to explain that we wouldn't continue active treatment if their mum takes a turn for the worse. I felt slightly out of my depth, as it wouldn't be my decision to discontinue active treatment, and as I'd only been a real doctor for two days had never had the opportunity to lead such a conversation before. If I said the wrong thing in the wrong way the whole encounter could go horribly wrong and the family's faith in me and in our team could be diminished.

So I fell back on my commuication skills teaching from medical school. Step 1: find out what they know already. This turned out to be a good strategy because it meant the relatives actually did all the talking for a good 5 minutes. Cue an outpouring of the story so far and their feelings, which allowed me to pick up on the fact they already knew she was DNAR and they already knew she'd had a very big stroke, and they already knew she was very unwell. This gave me a good link to start talking about "if things get worse, keeping her comfortable", which they took on board very well. I was also able to explain what were doing for her in terms of treating the infection, which gave them some reassurance that we hadn't given up on her.