Skip to content

Breaking Bad News / Death & Dying - Cambridge medical student VLOG #25

2018-02-24 · Vlog or day in the life · Ali, Steve 293Eebb45F, Paul, a guest · recording, 12:19 · watch on YouTube

Topic: Medicine and his doctor years · mode: Explanation and tutorial · tags: His medical past

Ali films the two-day Death and Dying course of his final year at Cambridge clinical school and explains what it taught: the first steps of breaking bad news, do-not-resuscitate conversations, palliative care for breathlessness and at home, and why medical students dread breaking bad news.

What is said

The parts of the video and what is said in each (★ — how much it matters to the video).

00:00:00 — The two-day Death and Dying course begins; Steve explains its purpose

  • ★★ In his final year Ali takes part in a two-day Death and Dying course on breaking bad news, working with actors trained to cry on demand. — 00:00:06
  • ★ Steve 293Eebb45F: Steve, a clinical communication skills coordinator, says the two-day course of lectures and experiential sessions makes medical students think about challenges of their early years as doctors. — 00:00:06 · Clinical communication skills

00:00:53 — Breaking bad news in a role play: the patient's starting point, warning shots, group feedback

  • ★★★ Ali says the first step in breaking bad news is always to establish the patient's starting point, what they have been told, so that a doctor new to the patient never discusses the next step of a cancer treatment with someone who was never told they had cancer. — 00:01:17
  • ★★★ Ali advises giving warning shots instead of dropping bad news in one go, starting by taking the patient into a side room, never breaking it in a corridor or on the ward. — 00:01:47
  • ★★ Another warning shot before bad news, Ali says, is asking patients to describe in their own words how their condition has worsened, such as how they felt six months ago compared with now. — 00:02:34
  • ★ In every communication skills session Ali asks the group to watch whether he is talking too fast, which he tends to do. — 00:03:03 · Clinical communication skills
  • ★★ a guest: In feedback, a session leader advises naming the patient's priority, being at his daughter's wedding, and working towards it, which needs a good grasp of how severe his condition is. — 00:03:49

00:04:11 — Why communication skills sessions work well in a group of friends

  • ★★ Ali finds doing heavy communication skills sessions such as breaking bad news with a group of friends a nice way to do them; one-to-one would feel too intense. — 00:04:11 · Clinical communication skills
  • ★ At Cambridge, communication skills sessions are mostly done in groups, with one-to-one sessions a couple of times a year. — 00:04:11 · Clinical communication skills
  • ★★ Ali says his friendly, supportive communication skills group was a safe space to make mistakes, and he really likes the sessions. — 00:04:40 · Clinical communication skills

00:05:10 — Do-not-resuscitate conversations and how rarely CPR succeeds

  • ★★★ Ali explains that whether to attempt CPR is technically a medical decision a patient cannot demand, yet doctors discuss it, explaining the patient's best interests and weighing patient's and family's views. — 00:05:15 · Do not resuscitate, Best interests
  • ★★ A do-not-resuscitate conversation can be tricky, Ali says, because patients often take it to mean doctors are giving up on them or will not do their best in other treatment. — 00:05:44 · Do not resuscitate
  • ★★ Ali says CPR is rarely successful, with a success rate of about 7%, and is less life-saving than it seems on Grey's Anatomy. (hedged) — 00:05:44
  • ★★ Ali cites a study that compared CPR survival rates in television dramas with real life and found a massive disparity. — 00:06:12
  • ★★ For some people, especially those with underlying health problems, CPR can do more harm than good, Ali says. — 00:06:12

00:06:36 — Lectures on breathlessness at the end of life and the ethics of end-of-life care

  • ★★ From a palliative care consultant's lecture, Ali reports that oxygen does not help breathlessness at the end of life, against common belief, and non-drug approaches do. (hedged) — 00:06:41
  • ★★ Ali reports that drugs such as benzodiazepines are not that useful for breathlessness at the end of life; non-drug approaches make the difference. — 00:07:11
  • ★★ Non-drug approaches to breathlessness need time and engagement from doctor and patient, so in many NHS hospitals they are rarely used, Ali says. — 00:07:11 · NHS
  • ★ Ali calls a lecture by an A&E consultant on the ethics of end-of-life care, including assisted suicide, euthanasia and do-not-resuscitate forms, wonderful. — 00:07:11 · Assisted suicide, Euthanasia, Do not resuscitate
  • ★ Katherine cooks Thai green curry for dinner after the first day of the course. — 00:07:51 · Katherine

00:07:58 — Katherine cooks Thai green curry

  • ★ Ali's mum says his medical-student vlogs are more cooking and food vlogs; Ali says he enjoys filming and editing those sequences. — 00:08:32 · Ali Abdaal's mother

00:09:11 — Day two: telling a mother her son has died, palliative care at home, the wife of a dying patient

  • ★★ On day two each of six students practised telling a mother that her 21-year-old son had died in a car accident; she reacted differently each time, crying, shocked silence or anger. — 00:09:11
  • ★★ Ali finds practising news of a young person's sudden death in his final year, before doing it for real, super useful. — 00:09:40
  • ★★ Ali reports the lecturer Dr Barclay's point that in the last hundred years death and birth have been over-medicalised: most once happened at home, now most happen in hospital. — 00:10:10
  • ★★ Near the end of life doctors ideally keep patients out of hospital, Ali says, because hospital care is expensive and patients often prefer to die at home. — 00:10:10
  • ★★ Palliative care at home works with Macmillan nurses, Marie Curie nurses, hospice workers, social care and hospice at home to keep dying patients comfortable. — 00:10:39
  • ★★ In a role play with the wife of a dying man who wanted his body taken away by ambulance, students explained he would probably not survive the trip, explored her worries and brought her round to his dying at home as he wished. — 00:11:08 · Clinical communication skills

00:11:37 — What the course was worth, and the dreaded breaking-bad-news interview station

  • ★★★ Ali says medical students fear breaking bad news: a breaking-bad-news MMI station scared him as an applicant, and in five years of teaching interviews it is the station every student dreads. — 00:11:37 · Multiple mini interview
  • ★★ Ali finds the Death and Dying course's intensive practice in breaking bad news really useful preparation for life as a junior doctor. — 00:11:37

Threads in this video

Where the stories that moved here went next

Mentioned

Central: Clinical communication skills · Do not resuscitate

Also: Ali Abdaal's mother · Assisted suicide · Best interests · Euthanasia · Katherine · Multiple mini interview · NHS · Paul

Only in the description or credits: University of Cambridge

← Previous: Another Day of Fun (La La Land) - The Prion King · Addenbrooke’s Hospital Pantomime 2018 · Next → Lacrosse and A&E - Cambridge University medical student VLOG #26