DNACPR discussions - the bread and butter for every doctor regardless of your grade or specialty. And as a junior doctor, you’re probably the one who spends the most time with patients and their families. Different trusts will have different policies as to who can sign the legal DNACPR document, however having the discussion is something anyone in the team can do. Everyone has a different way of approaching the topic and there are no set rules on what's the best way or worst way to do it. But here's my advice if you're freshly graduated or new to the country, don't “over-medicalise” the discussion and keep it simple.

DNACPR (AKA Do Not Attempt Cardiopulmonary Resuscitation) - it means that in the scenario where one's heart and lungs stop, the medical team will not perform resuscitation which involves chest compressions and delivering strong electric shocks in the attempt to restart the heart.

It is important to explain to patients or their family members what resuscitation involves and the facts of the situation. Providing facts to help others understand is part of our job. I find quoting the rate/likelihood of ROSC (return of spontaneous circulation) in an inpatient as per the resus guidelines to be helpful, and that the survival rate, unfortunately, reduces as one either ages or has co-morbidities. The road to recovery after successful ROSC is long; it requires significant time and is often accompanied by complications of its own. It is also important to clarify that this decision does not mean that treatment is withdrawn.

A DNACPR decision is a medical decision and it is important to keep in mind that, as a doctor, you have the privilege of knowing what the facts are and making a life-changing decision; it is important to take this seriously, without putting the burden on the patient or family.

I have had many DNACPR discussions until now but there are a few that you never forget; one example that I still often think about is when the teary wife of a patient of mine said to me that she couldn't make the decision to end her husband’s life, and when I told her that the responsibility of this decision lies with me, not her, she cried even harder. She left that evening after her husband passed away, thanking me for taking the guilt away.

Being able to confidently have a good DNACPR discussion makes a huge difference in the care being delivered by us and received by patients and their loved ones. And just like me, after a couple of discussions, a few misspoken words and a pandemic, I’m sure everyone can develop this crucial communication skill in our daily practice.