Either the BMA/RCN/RC(UK) is being stupid or I am - which is it ?
Either the BMA, RCN and RC(UK) have written something which is plainly 'stupid' in their recent revised guidance about cardiopulmonary resuscitation (CPR), or I'm being stupid here: opinions very welcome, about which it is.
The guidance contains this section, and the context is that the BMA, RCN and RC(UK) do not like the idea of patients or relatives, co-signing 'official' records - I adopt the opposite position, that we need to get patients and relatives to sign certain records, to validate those records (see the link):
15.2 Co-signing of CPR decision forms
In the past, in some paediatric settings, parents have been asked to sign CPR decision forms. This is not advisable and can cause unnecessary additional distress. Some healthcare professionals have suggested that adult patients should sign CPR decision forms, in a similar way that patients provide signed consent to treatment, such as an operation. This is not a legal requirement. Such a policy could be an obstacle to effective end-of-life care for some dying patients for whom discussions about CPR decisions will be potentially harmful and unnecessary. There is no requirement for those close to patients to sign forms to confirm their agreement with/to a DNACPR decision. Asking them to do so could contribute to them inferring incorrectly that they are being asked to make the decision. It is common for those close to patients to misinterpret or forget precise detail of what they are told at such times, when they are understandably anxious and often tired. For this reason it is crucial that healthcare professionals document details of such discussions and explanations clearly in the patient's health records.
Now - and I've pointed this out directly to the BMA/RCN/RC(UK) - sticking to adults, and ignoring my 'section 4 imposes a duty not authority'/'best-interests decision-making' issues, there is something strange in there, even on its own terms.
Forgetting what the clinicians tell you, is one thing: but 'it is common for those close to patients to MISINTERPRET what they are told', followed by 'so it is crucial for HCPs to document details of such discussions', is paradoxical. If HCPs are not clear [in their own minds], that their statements are not being 'misinterpreted', then they should be re-stating things, until there is no misinterpretion: this is supposed to be about communication, not mis-communication !
And the simplest way to discover whether 'a conversation was at cross-purposes', is to show your description of the conversation [after you have written it down] to the other person(s) involved: to be blunt, if clinicians are HONESTLY worried about 'the laymen misperceiving what we told them', then after the clinicians had recorded their version of a conversation in the medical notes, they would allow the laymen to read it, and then either write 'I agree that is what was said' or else to write in the notes 'I don't think we had that discussion at all - what I think was said, was ...'