Communicating about a serious illness is hard. Last week’s podcast we talked about the challenge around miscommunication in serious illness. This week we dive into the challenges with communication when it comes to life sustaining treatments and CPR. Take for example the simple question:

“If her breathing gets any worse, she will need to be intubated.”

This seems like an innocuous statement of fact, but does she really “need” to be intubated if, for example, her primary goals are to be comfortable and die at home?  Of course not. 

We’ve invited Jacqueline Kruser and Bob Arnold on this week's podcast to talk about their recently published JAMA Viewpoint article titled “Reconsidering the Language of Serious Illness.” I love this article as it specifically discusses what’s wrong with “need” statements and how we can shift our communication and thinking to create space for deliberation about patients’ priorities and the best course of action.  

We’ve also invited Sunita Puri to talk about the language of life sustaining treatments, in particular CPR. Sunita recently published a wonderful New Yorker article titled The Hidden Harms of CPR arguing among other things that these conversations “are procedures, demanding the same precision of everything else in medicine.” 

So take a listen and check out some of these other links to dive deeper:

• Our first podcast in the series of 3 podcasts “Miscommunication”

• A great article on why you shouldn't ask what patients “want”

• Sunita’s book That Good Night: Life and Medicine in the Eleventh Hour

• The paper Jacky talked about regarding the ingrained pattern of focusing on the “need” for specific life-sustaining interventions, typically as the reason to admit a patient to the ICU

• Changes in End-of-Life Practices in European Intensive Care Units From 1999 to 2016

• Cardiopulmonary Resuscitation on Television — Miracles and Misinformation

• Code Status Discussions Between Attending Hospitalist Physicians and Medical Patients at Hospital Admission