Keeping people "alive"

[nvshelat]

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I apologize in advance for my ignorance (MS2 here)

Do those of you in the CC field feel as though you have difficulty (morally) with the profession when sometimes you're just keeping people "alive" who really need to be (for instance) taken off the vent? I'm wondering how physicians deal with the enormous emotional and ethical burdens in CC

 

[doc02]

There's no moral concern, there's just a sense of frustration with the situation. It's basically family members who either don't understand the situation (despite explanation) or who refuse to accept it. Additionally, as with most critical care, there's a huge component of "I don't have to pay for it, so I demand everything." You'll find that with most medical care in America that if you tell the family that they have to pay for it, everything suddenly drops into perspective. For example, some patients refuse to leave the hospital "until you can guarantee that I never have to come back because my health is important to me." But once you fill out the necessary papers and tell them they have to pay for their stay, they suddenly realize that they don't need such stringent requirements.

I have no problem with expending large amounts of resources to HELP someone, however. That's different from expending large amouts of resources in a futile pursuit of self-indulgance. And the problem is that many people who love and demand socialized medicine on the left confuse the two. Because socialized medicine demands rationing, they view anyone who utilizes more than "their fair share" of resources as "self-indulgant" and it's a shame that this type of system forces a person to think that way. However, it is also a reality because you have to work with the system.

 

[chocomorsel]

I'm a 4th year going into anesthesia and very interested in CCM. I can see how some of the care given in the ICU can be a waste of resources. For example and MVC with a 20something year old whose GCS in the field was 3, pupils are fixed and dilated, has been non-responsive this whole time, but he still has vitals. Or an 80'something with multisystem failure who's on the vent and family wants everything done, cuz guess whose paying for it? Medicare. I know miracles happen, but sometimes I think that physicians just need to stand their ground and not engage in practicing futile medicine by operating on these patiens, putting them on vents and drips, dialyzing them etc. Humans aren't meant to live forever. I think if physicians did that, then resources wouldn't be wasted on patients who have no chance at life. But I bet that the reasons money is wasted on many of these patients is probably due to the threat of lawsuits if the patient isn't kept alive until the family is given the whole story and decision making capability prior to "Pulling the plug".

Many times though, family just gets in the way, because they equate a beating heart with a live patient. And we can't fault them because we probably thougth the same way before our exposure to the medical field. Anyway, my rant is over, but I do see a lot of resources wasted on futile medicine. You are right though, if we told them to pay up like third world countries do, they'd be quick to agree with the MD.

 

[doc02]

I know miracles happen, but sometimes I think that physicians just need to stand their ground and not engage in practicing futile medicine by operating on these patiens, putting them on vents and drips, dialyzing them etc.

Just so you know for the future, if a family wants "everything done," you may not actually have to do literally everything, but you have to provide anything that would reasonably be necessary for support. That does, in fact, include operations, vents, drips, and dialysis. This is not a choice you have and although lawyers are ****heads and a$$wipes, this specifically is not their fault but the fault of ourselves and the often-lame field of medical ethics. Lawyers just hold us to our own stupid laws, generally in a distorted manner to make money, but it's still our own fault.

Many times though, family just gets in the way, because they equate a beating heart with a live patient. And we can't fault them because we probably thougth the same way before our exposure to the medical field.

I hate it when people act like laypersons are completely oblivious to outcomes because they are not physicians. Sure, we obviously have an added level of understanding, but I'm pretty sure that even if you took a high-school kid and showed them some of the people in the ICU they'd be able to figure out that these people generally aren't long for life. And I'm pretty sure they could figure out who was there just for monitoring (e.g., the person sitting around reading a paper who had splenic trauma and was being observed for stability) and who is there because they're about to bite the dust. People who use "they're not doctors" to excuse the deliberate blindness of many of these families are complicit in the problem. Again, you make these people pay for the medical care and all of a sudden they come to their senses and can see things just as clearly as a physician ...amazing!!!!

 

[chocomorsel]

Just so you know for the future, if a family wants "everything done," you may not actually have to do literally everything, but you have to provide anything that would reasonably be necessary for support. That does, in fact, include operations, vents, drips, and dialysis. This is not a choice you have and although lawyers are ****heads and a$$wipes, this specifically is not their fault but the fault of ourselves and the often-lame field of medical ethics. Lawyers just hold us to our own stupid laws, generally in a distorted manner to make money, but it's still our own fault.




I hate it when people act like laypersons are completely oblivious to outcomes because they are not physicians. Sure, we obviously have an added level of understanding, but I'm pretty sure that even if you took a high-school kid and showed them some of the people in the ICU they'd be able to figure out that these people generally aren't long for life. And I'm pretty sure they could figure out who was there just for monitoring (e.g., the person sitting around reading a paper who had splenic trauma and was being observed for stability) and who is there because they're about to bite the dust. People who use "they're not doctors" to excuse the deliberate blindness of many of these families are complicit in the problem. Again, you make these people pay for the medical care and all of a sudden they come to their senses and can see things just as clearly as a physician ...amazing!!!!

I said "many times". Doesn't mean all laypersons are oblivious, but many are. There are a lot of things that they don't understand. And the shock they initially feel if the acute event is unexpected doesn't help in decision making either.

 

[europeman]

I don't know what institutions you guys are at, but at mine, "futile" patients are not given care per the discretion of the family. Instead, the physician meets with the family, and explains the situation, and in the instances when the family still refuses, the physician tries again. If that fails, when I was on the rotation, the physician offers the family the option to find care from another physician at another instutiion if they wish (which they never are successful at doing).

Then the ethics committee is called, which always agrees with the doctors, and then the head of the hospital is asked permission (i don't know why, but they are), and care is withdrawn. The family is given ample opportunity and explanation, but in the end, care for a futile patient stops in the ICU within 5 working days in the two instances where I've been a student on the rotation.

Surgeons, especially, are not FORCED to do anything they don't want to do. If you think an operation is futile, no ones forces you to do it... including lawyers. You just have to go through the steps, and document.