Some Junior Doctors 'Out of their Depth' During End of Life Discussions

Peter Russell

January 22, 2021

More than half of junior doctors polled at a busy London hospital coping with the COVID-19 pandemic found themselves 'out of their depth' during resuscitation discussions with patients and their relatives, a survey found.

The small study, yet to be published, suggested that a lack of postgraduate training and hands-on clinical experience may have contributed to their difficulties.

In normal times, end of life care discussions would usually be led by senior doctors. However, exceptional pressures during the current pandemic led to this work sometimes being delegated to more junior colleagues, particularly during out-of-hours.

"In many cases junior doctors would be engaging in discussions that may have been deemed exceptionally challenging for even the most experienced doctors," explained Dr Edmund Lodwick, a junior clinical fellow at King's College Hospital intensive care.

His findings, presented at this month's Winter Scientific Meeting of the Association of Anaesthetists, called for further research to establish the impact of the findings on patient care.

However, he told Medscape News UK: "I think from a personal experience, I don't think this impacted patient care at all."

Online Survey

Dr Lodwick analysed the situation at Croydon University Hospital, where he spent his own foundation level training.

He conducted an anonymous online survey of 75 foundation doctors, and other doctors at equivalent level, who were asked nine questions on how they handled resuscitation discussions, three of which related directly to the pandemic.

  • 51% found that the pandemic increased resuscitation discussions 'a lot'

  • 62% of foundation doctors found themselves out of their depth during resuscitation discussions 'a lot'

  • 94% were unaware of any specific resources available to doctors to aid discussions regarding resuscitation

Foundation doctors also frequently found patients to be misinformed regarding resuscitation, with 97% unable to point patients to specific resources to clarify their questions.

'Emotionally Stressful'

The situation "definitely does have a negative effect on everyone's emotional and mental wellbeing," said Dr Lodwick.

While stressing that Croydon University Hospital was "absolutely fantastic" in its handling of the pandemic, he added it could be "very distressing for the patient, obviously, but it can be very emotionally stressful for doctors" too.

Dr Lodwick said: "While further research is needed from other hospitals, it is likely this same problem is being experienced by junior doctors up and down the country.

"Further research and training in this area would help to guide a widespread series of interventions to empower junior staff nationwide in dealing with these extremely challenging end of life situations."

The study has not yet been submitted to a journal for publication.

The abstract is available in Anaesthesia, a journal of the Association of Anaesthetists.

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