Recently, I saw a series of videos, vblogs or whatever the younger crowd is calling them these days about DNRs, and end of life care being discussed, and the resulting commentary was frankly disturbing. This lead to a discussion with some trusted colleagues (fellow medics) as well as a family member of my own who is a BSN and RN. One of the scariest things I’ve found, in general, is that many many people treat DNRs as “do not treats” regardless of the “level” of DNRs. An example in my state, is there are DNR B (Palliative only) vs DNR A/DNIs, which is “do everything except intubate” and they still don’t try as hard. Without delving deep into the multitude of studies, they do exist showing that even in facilities, staffs don’t try as hard regardless of “types” of DNRs when they exist. I bring all this up as a preamble to the core of these underserved patient populations.

Arguably, you’d think the job of explaining the DNR/MOLST/POLST form (depending on your state) would fall on the hospitalist and/or hospice group right? Except often times they’re all too busy to do so. Often times just what is on the DNR form isn’t actually explained to a patient. How often do you see the front page checked “palliative only” yet the back page (the one for the inpatient stuff) shows “do everything.” I had a patient once where no one explained the difference to them at what DNR A1, DNR A2 (DNI) and DNR B meant. They literally had no idea what they were signing, nothing was explained to them. On the other hand, when they are sent home on hospice care often times they just get dropped off by a private EMS transport and left… with little to know information or even planning or care in how to help arrange their homes to help prevent future calls.

Often times, family members call us because they don’t know what to do. We are their last line of defense, the solution to the “hand in the air, I’m lost.” An abbreviated example, I was called for a service call to a residence to assist a family member with her recently returned to home husband who had been placed into hospice care. The IFT crew had just brought him home and left him in his upstairs bedroom. They’d provided no guidance on helping her prepare the home for him, or how to setup the house for his end of life care. The hospice team had not gone over any of the papers with her, none of the MOLST forms, DNR forms, living wills, etc. Now being on the fire engine, we don’t carry stair chairs (she had asked us to help move him downstairs) so we had called for an ambulance to bring one to us non-emergency, while we waited I decided to go over some of this stuff with her. Spent the next 20 minutes or so helping her rearrange some furniture, plan how to setup her home, go over the MOLST form, what numbers in the folder to contact regarding the living will etc. Explaining what to call for, what we need we can help her with, what we can’t actually help her and everything else. In the end, the extra 20 minutes spent with the patient’s spouse set her mind at ease, has definitely alleviated further calls for service that many would call “useless” or “wasteful” and improved the quality of life for the patient in his end-of-life care for comfort in the end of life care.

The bottom line here, is that while less than maybe 5-10% of the calls are “guts and glory” we should be pay attention to the other 90-95% of the calls. Take the extra few minutes, even if you’re tired and don’t want to, to just speak for a few minutes to the family members. Those few minutes might save you an hour or two later. That public perception makes a big difference later.

The post The Underserved community within our community. first appeared on The Hazmat Medic.