DESIRABLE HABITS OF THE GOOD EMERGENCY DEPARTMENT DOCTOR448 Administrative and Legal Issues
2 Write a letter, keeping a copy in the patient’s medical record, if:
(i) The GP writes a referral letter to you.
(ii) You do any tests, including bloods, urinalysis, ECG or X-ray,
even if they are normal.
(iii) You make a new diagnosis.
(iv) You start new medication, or change or stop an existing
treatment regimen.
(v) You refer the patient back to the GP for further care and review,
including removing sutures or changing dressings.
(vi) You refer the patient to outpatients.
(vii) The patient is admitted, or a patient is brought in dead (or dies in
the department).
3 Fax the letter, and give the patient a copy to deliver by hand.
(i) Assume it is likely to be opened and read, so fax, post or email
only letters containing sensitive information, and when you
have any doubt about the reliability or capacity of the patient to
transfer the letter on.Breaking bad news
1 Breaking bad news to a relative concerning critical illness, injury or sudden
death, especially when unexpected after trauma or cardiac arrest, must be
done in the privacy of a quiet relatives’ room.
2 Be accompanied by an experienced nurse and/or social worker. Introduce
yourself, identify the patient’s nearest relative, and sit by them.
3 Come to the point avoiding pre-amble or euphemisms. Use the words ‘dead’
or ‘death’ or ‘critically ill’ early on, followed by a brief account of events.
4 Be prepared to touch or hold the relative’s hand and do not be afraid to show
concern or empathy yourself. Allow a period of silence, avoiding platitudes
or false sympathy, but encourage and answer any questions.
5 Understand that the relative’s reaction may vary from numbed silence,
disbelief, acute distress to anger, denia l and guilt.
6 Encourage the relative, when ready to do so, to see and touch the body in
cases involving death, and to say goodbye to their loved one alone.
7 Indicate that the nurse or social worker can stay with them.
8 Ask whether the relative wishes the hospital chaplain or bereavement
counsellor to be contacted. Avoid giving sedative drugs, which will only
postpone acceptance of what has happened.
9 Telephone or fax the GP and inform the coroner if appropriate.
10 Retain the property of the patient, whatever its condition, for collection by
the next of kin in accordance with his or her wishes. Avoid then presenting
the property in a plastic bin bag.