Communication for the intensive care specialist
- planning for effective, efficient and compassionate interactions 
Example of content:

Mr Branko Kovac is a 76 year old man with severe cardiomyopthay and emphysema. He easily develops left ventricular failure (despite optimal medical management). He has has 3 admissions to ICU during this admission to hospital (though you were away on leave and have never seen him yourself).

Each time he has been admitted to ICU he has rapidly improved but after being discharged to the general ward he has quickly 'bounced back'.

The physicians (under whose bed card he has been admitted) do not feel there is any further treatment which they can offer, indeed they comment that it is 'amazing how he keeps going'.

Your team call you because a MET call has just been called for Mr Kovac. He is semi-conscious with rapid AF and pulmonary oedema.

Mrs Sylva Kovac is with her husband. Please can you discuss Mr Kovac's treatment with her.

Particular Issues in this Scenario

This is an unfortunate situation. It appears that there has been no planning for this situation (despite the probability of deterioration) – maybe because you were away!. The opportunity to determine Mr Kovac's wishes looks like it has passed (though it is possible he has expressed wishes that we don't know about). We will need to rely on surrogate decision making (which is likely to be less reliable and more difficult. The name suggests that English may not be a first language (suggesting communication problems and cultural approach may be unusual.




Anticipated actions of Sylva

To be indecisive. To have little idea of what she is being asked so urgently and why she is being asked to decide. It is more likely that she will have a cultural or emotional bias to demand intervention rather than to accept that further invasive treatment is not appropriate. She may also take the position that failure to get her husband better is a sign of error on the part of the hospital ('look what has happened, you should never have sent him out of ICU')

Actions Expected of Candidate


Appropriate body language

Clear explanation of the medical situation

Asks if discussions about limits have occurred

Empathy, not bullying

Gives time for consideration

Responds to questions

Establishes who are the family decision makers

Things you might say

How do you feel things have been going

What do you understand about his medical condition? (this is to see if she understands how bad he is and that it can't be fixed)

He has got a bit better each time but not well enough to come home. Each time this happens it is frightening for him. I am concerned that his heart is so bad that he can't manage on his own.

Had he said anything to you about his feelings about his time in hospital.

Things you should not say

Do you want us to do everything?

If we are going to save him we need to intubate him now – what do you want us to do?

Last time when he left ICU he had a 'one way ticket' we have agreed that he is not coming back. (ie.we have decised without talking to him or to you)