Identifying and communicating with high-risk patients

24 April 2020

Advance Care Planning

Last week Peter and I had a Zoom meeting with the Older People’s Commissioner and as you can imagine Advance Care Planning was one of the topics we discussed.

Advance Care Planning is an important part of good general practice and usually we have the benefit of knowing our patients and being able to approach this gradually with an individual patient over a period of time.

Identifying high-risk patients

However, identifying patients at high risk of Covid and approaching them to discuss such plans has been a difficult challenge for most GPs and GP practices.

Many patients have not appreciated having a “cold call” from their GP and have taken it to mean denying treatment rather than tailoring care to an individual’s needs and wishes.

Guidance on having difficult conversations

We published guidance on having these difficult conversations and having listened to feedback from patients and doctors would suggest taking the following into consideration:

  • Remind patients that even in the higher risk groups they are statistically more likely to survive than die from Covid-19.
  • For some patients their chance of survival is not improved by admission to hospital.
  • There might be no medical benefit, but a less comfortable surrounding than if they had decided not to be admitted.

What is the patient's choice?

It is important that patients have the opportunity to make their wishes known while they are well so that medics and carers do not make choices, they would not be happy with and that patients are aware that these wishes can be changed at any time.

It is probably best to leave the Do Not Attempt CPR conversation for the patient to raise or to give the patient time to think about the discussions and have a follow up call which could then involve DNA/CPR.

I always remember a patient I had known well for 40 years who repeatedly told me I was not, under any circumstances, to admit her to hospital.

When I asked her about having a DNA/CPR form at home she refused to sign it but still insisted on not being admitted! These conversations are not straightforward and are very emotive.

Thank you for everything you are doing during the Covid emergency.

Take care and stay in touch,

Post written by

Dr Mair Hopkin, Joint Chair of RCGP Wales

Dr Mair Hopkin qualified in 1980 and was until 2019 a partner at the Old School Surgery in Pontyclun. She has served as Chair and Provost of the South East Wales Faculty, as well as being Faculty Representative to RCGP’s UK Council.

Mair has a keen interest in child development and child and women’s health. She introduced a Well Baby clinic before it became part of the GP contract, and has co-authored a book on Child Health Development in Wales. She has also developed an interest in medical education, currently an Associate Dean in the Wales Deanery.

She married a farmer and lived on a working farm for three decades. She has three children, one of whom is a GP, and four grandchildren. Outside of medicine, her hobbies include spinning wool, knitting, reading and destructive gardening (“I’m good at pruning and digging but not growing things”). She is a Welsh learner.

Find courses & events

The item has been added to your basket.

Continue shopping

Go to basket

This item is out of stock.

Continue shopping

The item is out of stock.

Yes Continue shopping

An error occurred adding your item to the basket:

Continue shopping