October 22nd, 2020

Coronavirus is here; now what do we do?


By Submitted Article on April 22, 2020.

Daren Heyland

CRITICAL-CARE PHYSICIAN

There is currently a great deal of suffering in our communities from the health consequences of contracting COVID-19, and from the social and emotional consequences of being isolated along with the economic consequences of so many businesses having to close their doors. >I am sure most people are nervous or anxious about what the future will bring. Many are asking, “What can I do to prepare for this pandemic?”

Having been a critical-care physician for over 20 years, I want to try and offer some advice on what people can do to prepare for serious illness. My comments are based on decades of being a witness to people who are ill-prepared for illness or tragedy that has often unexpectedly struck them or a family member.

While it is true that most people who have COVID-19 are not that sick or can be managed symptomatically at home, some will develop breathing difficulties and require hospitalization and admission to an Intensive Care Unit (ICU) for support with breathing machines. Unfortunately, 1.5-7 per cent of all patients with COVID-19 succumb to their disease. All of this disease and death is causing tremendous human suffering and putting an unprecedented stress on the health-care system. Decision-making about who gets admitted to the hospital or who gets admitted to the ICU is and will only continue to be difficult as resources to manage the illness are limited and in short supply.

So, what can you do now to prepare for COVID-19? You need to learn and understand how medical decisions are made when people are seriously ill and what you have to say and how best to work with the doctors, so you get the medical care that is right for you. Any advance medical-care planning that you may have done, which has likely been focused on “end-of-life” care, will not be helpful in the current situation. Planning for end-of-life care, when you know for certain you are dying, is not the same as planning for serious illness.

COVID-19 is an example of a serious illness where there is a probability of death as well as a probability of survival. Unfortunately, doctors will have to make treatment decisions about whether you should go to an ICU or go on breathing machines BEFORE they know your outcome (whether you are going to live or not). If you were to get sick with COVID-19, to make it easy on the doctors having to make these difficult decisions as well as ensuring you get the care that is right for you, you should be able to verbalize your answers to the following two questions:

1) When considering the treatment options for serious illness, are you the kind of person who wants treatments to focus on prolonging life or focusing on improving the quality of remaining life?

2) Are you the kind of person who is open to the use of “machines” or artificial measures to sustain your life or do you prefer to have a natural death when you are ill (no breathing machines, etc.).

The point of these two questions is to help you see that you can’t have both of the options in each question; they compete or conflict with each other. Doctors can then make sense of the answers to these questions to make sure you get the medical care that is right for you. If you are interested in learning more detailed information around how the answers to these questions connect to medical treatments, check out the online planning tool, Plan Well Guide (www.planwellguide.com). This guide is free to use and, best of all, includes tools to help people clarify what is important to people along with information on the risks, benefits, and possible outcomes of critical care, medical care and comfort care.

Working with family doctors at Family Medical and Bigelow Fowler here in Lethbridge, we recently evaluated Plan Well Guide. In a randomized trial that will be published this month in CMAJ Open, we compared Plan Well Guide to usual care; we showed that the novel decision aid improved the quality of decision-making and reduced time that the family doctors spent with their patients finalizing their “Goals of Care Designation” form. This seems like a “win-win” in that patients get the support they need and the decision-making encounter requires less from doctors. I strongly recommend that you prepare for serious illness and go through the serious illness planning program easily accessible to all by visiting http://www.planwellguide.com.

Daren Heyland is a critical-care physician, a Lethbridge resident, and founder of the online tool, Plan Well Guide.

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