Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM , where we instantly improve the lives of Families of critically ill Patients in Intensive Care, so that you can have PEACE OF MIND, real power, real control and so that you can influence decision making fast, even if you’re not a doctor or a nurse in Intensive Care!
In last week’s blog I showed you
and if you haven’t read, watched or listened to the update, you can check it out here.
In this week’s blog I want to talk about
“THE 5 QUESTIONS YOU NEED TO ASK WHEN THE INTENSIVE CARE TEAM IS TALKING ABOUT “FUTILITY OF TREATMENT”, “WITHDRAWAL OF LIFE SUPPORT” OR ABOUT “WITHDRAWAL OF TREATMENT!”
No other situation or topic in Intensive Care is causing more emotion, discomfort, angst, controversy and irritation than end of life situations and/or the situations and discussions that lead up to it- And rightly so, because life is extremely precious.
More importantly, you need to be highly sensitised and alert whenever the Intensive Care is talking about “Futility of treatment”, “Withdrawal of life support” or about “Withdrawal of treatment”, especially when it relates to your critically ill loved one’s treatment!
After more than 15 years Intensive Care nursing experience in three different countries, I have been involved in many end of life situations and I have seen many situations where the Intensive Care team has positioned critically ill Patients’ prognosis, diagnosis and their ongoing treatment as “futile”.
Futility of treatment is also defined as “justification of a decision not to pursue certain and ongoing medical treatment that may be requested or demanded by Patients or their surrogates”.
“Withdrawal of life support” and “Withdrawal of treatment” are in the same category than “Futility of treatment” and the reality in Intensive Care is that the difference between the three statements is negligible and grey, as they all have the same end goal in mind, which is basically not to extend treatment and let a Patient approach their end of life and die. And this may well be in the best interest of a critically ill Patient and a Family.
However, in many cases “Futility of treatment”, “Withdrawal of life support” and/or “Withdrawal of treatment” are strong statements to make by the Intensive Care team and you need to know and understand why the Intensive Care team positions your critically ill loved one’s prognosis and diagnosis that way and how this positioning may impact on the course of your, your Family’s and most importantly your critically ill loved one’s trajectory of their stay in Intensive Care.
You need to know where you stand, irrespective of the Intensive Care team’s positioning!
You also need to have your and your Family’s positioning worked out when entering those discussions, because otherwise the Intensive Care team will make decisions for you and for your critically ill loved one if you come unprepared and the Intensive Care team will walk all over you and make decisions that suits the Intensive Care Unit’s needs and not your and your critically ill loved one’s needs.
Your positioning during those discussions is so important that I can’t stress enough that the Intensive Care team is prepared to “pull the plug” on your critically ill loved one, if you don’t have your “act together” so to speak. After all, you, your Family and your critically ill loved one are in a unique and often “once in a lifetime situation” that is defining the rest of your life. Therefore you want to have as much information, support and education available that gets you through this difficult situation.
Putting your emotions aside for a moment is crucial!
Whenever you’re faced with a challenge like end of life in Intensive Care there are a multitude of questions you need to ask and it’s important that you approach this topic rationally and that you put your emotions aside for a moment.
Most importantly, after having been involved in many end- of life situations in Intensive Care, I have found that you need to ask 5 distinct questions regarding the positioning of the Intensive Care team, as it relates to “Futility of treatment”, “Withdrawal of life support” and/or “Withdrawal of treatment” in your critically ill loved one’s situation. Because as it relates to other areas in life as well, in order to find the right answers you need to ask the right questions!
1. Does your critically ill loved one’s treatment cost too much time, money and resources that the Intensive Care team doesn’t want to invest?
Intensive Care is a place that is resource intensive and one day in Intensive Care costs $ 3,000- $ 5,000 per day(£ 2,000- £3,000 per day in the UK). Therefore, besides the clinical condition and prognosis of your critically ill loved one, the Intensive Care team is looking at your critically ill loved one’s condition and prognosis as a “business case” and will position your loved one’s case accordingly.
Imagine your loved one being in ICU with severe head injuries and a recovery might only be possible after many weeks in Intensive Care, would it be easier for the Intensive Care team to say that “treatment is futile” and that they would therefore “withdraw treatment” or “withdraw life support” for obvious reasons?
2. Are there other admissions awaiting treatment in Intensive Care and are they competing for scarce and expensive Intensive Care beds?
Beds and staff in Intensive Care are limited in numbers and they tend to be in high demand. If a Patient gets discharged, the next Patient is generally not far away and a bed in ICU never really gets ‘cold’.
What if your critically ill loved one is in an already fully occupied Intensive Care Unit and the Intensive Care team knows that in the next few days they will be overstretching their capacity.
The Intensive Care team knows that they have many Patients within the Hospital awaiting surgery and some of those Patients therefore need a bed in Intensive Care.
If they don’t empty some of the beds they will have disgruntled Patients, disgruntled Surgeons, Anaesthetists and a disgruntled Hospital administration. Therefore, often the easiest way out of the dilemma is to “sell” to you and your Family that the treatment of your critically ill loved one is “futile”. Again, you need to be highly aware and sensitive about those moving parts in Intensive Care, because if you’re not, the Intensive Care team might let your loved one die.
3. Does the Intensive Care team has a limited mindset and doesn’t believe in the recovery and the treatment of your critically ill loved one?
A limited or an abundant mindset can make a big difference in Intensive Care. If the Intensive Care team has a limited mindset and doesn’t believe that your critically ill loved one will recover, it’s a big challenge and something that can be turned around by your and by your Family’s positioning.
- The difference between “real” and “perceived” end of life situations when your loved one is critically ill in Intensive Care!
Often Intensive Care Unit’s with a limited mindset also have a negative culture within. They also tend to have negative outlooks and if you and your Family find yourself in such a limiting and inhibiting culture and mindset, your job is to challenge it and ask for what you want.
Many Intensive Care Unit’s have a positive culture and also abundant mindsets and they therefore are optimistic in their outlooks.
I have written a blog about culture in Intensive Care and how it impacts on your critically ill loved one’s treatment here
Other recommended resources:
- THE 5 THINGS YOU NEED TO KNOW IF THE MEDICAL TEAM IN INTENSIVE CARE WANTS TO “LIMIT TREATMENT”, WANTS TO “WITHDRAW TREATMENT” OR “WITHDRAW LIFE SUPPORT” OR WANTS TO ISSUE A “DNR” (DO NOT RESUSCITATE) OR AN “NFR” (NOT FOR RESUSCITATION) ORDER FOR YOUR CRITICALLY ILL LOVED ONE!
4. Does the Intensive Care team think it’s “sexy” to continue treating your critically ill loved one?
I know that this is a strong statement to make. and I make it anyway. You must know that in some Intensive Care Unit’s the latest technology that can save somebody’s life such as ECMO, Balloon pump(IABP), High frequency oscillation ventilation and many other of the latest technologies that may be used for your critically ill loved one’s recovery might be of interest for the Intensive Care team to use, as it’s perceived as “sexy” and interesting and it gets people excited. If none of these treatments or equipment is available or perceived as an option, again the Intensive Care team may position your critically ill loved one’s treatment as “futile”.
5. Does the Intensive Care team perceive you and your Family as weak or strong and do they think you have any knowledge about the Intensive Care environment?
This is another very important question you need to ask yourself and you need to have an awareness whether you and your Family are perceived as weak or strong by the Intensive Care team. If the Intensive Care team thinks that you and your Family take everything for Face Value and that you don’t question, your improving the likelihood that the Intensive Care team suggests to you and your Family “to withdraw treatment” or “to withdraw life support” and you have no control, power and influence.
If on the other hand, you and your Family are perceived as strong, knowledgeable, powerful and influential you are taking matters in your own hands and you are able to have control, influence and power.
How can you leverage your level of PEACE OF MIND, power, influence and control whilst your loved one is critically ill in Intensive Care and how can you be in control of the situation?
If you want to have control, power and influence whilst your loved one is critically ill in Intensive Care and if you want to be perceived as strong, influential, impactfull and knowledgeable by the Intensive Care team and if you want to be in control of your and your critically ill loved one’s destiny and if you want to make an impact, download your FREE “INSTANT IMPACT” REPORT NOW by entering your email below!
In your FREE “INSTANT IMPACT” REPORT you’ll learn how to speak the “secret” Intensive Care language so that the doctors and the nurses know straight away that you are an insider and that you know and understand what’s really happening in Intensive Care!
In your FREE report you’ll also discover
- How to ask the doctors and the nurses the right questions
- Discover the many competing interests in Intensive Care and how your critically ill loved one’s treatment may depend on those competing interests
- How to eliminate fear, frustration, stress, struggle and vulnerability even if your loved one is dying
- 5 “killer” tips& strategies helping you to get on the right path to PEACE OF MIND, control, power and influence in your situation
- You’ll get real world examples that you can easily adapt to your and your critically ill loved one’s situation
- How to stop being intimidated by the Intensive Care team and how you will be seen as equals
- You’ll get crucial ‘behind the scenes’ insight so that you know and understand what is really happening in Intensive Care
- How you need to manage doctors and nurses in Intensive Care(it’s not what you think)
Thank you for tuning into this week’s update and I hope that this episode has helped you how you can change the Intensive Care team’s perception about you and I’ll see you again in another update next week!
This is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and I’ll see you again next week with another update!