When doctor's die...

[michigangirl]

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We just had a slightly controversial thread on ICU care. Thought this article was very well written, wanted to share, since it's a slightly different topic but affects all of us. Pay special attention to the 2nd comment after the article by "Linda"

http://zocalopublicsquare.org/thepublicsquare/2011/11/30/how-doctors-die/read/nexus/

 

[PMPMD]

Linda says:
December 4, 2011 at 10:05 pm
When I was a third-year surgical resident we had an auto accident patient brought into the trauma room; he was a new patient to our hospital, we had no medical records on him, and no wallet to be found. Imagine our consternation when we removed his shirt to defibrillate, only to find "DNR" tattooed across the center of his chest. Was he "no-code", or did he just have unfortunate initials in an even more unfortunate location? Of course, when we found "DNR" also tattooed on his left flank where the second paddle is routinely placed, there was no further discussion. Resuscitation was terminated, much to the relief of the family who showed up about 15 minutes later.

Moral of the story? If you go with a tattoo, use TWO, one in each paddle position, to make your desires inarguable!

It would be pretty tragic if you later found out those were the patient's intials.

 

[foxtrot]

We just had a slightly controversial thread on ICU care. Thought this article was very well written, wanted to share, since it's a slightly different topic but affects all of us. Pay special attention to the 2nd comment after the article by "Linda"

http://zocalopublicsquare.org/thepublicsquare/2011/11/30/how-doctors-die/read/nexus/

Great article. Think how much money could be saved if we brought back the patient-doctor relationship and removed the lawyers. Medicare could easily be reformed if education about hospice became the norm rather than commercials for how you can sue someone because they received drug X in the hospital or had this type of mesh implanted in a surgery. The problem occurs when you didn't order than one test or give Factor 7 to the ailing 75 year old and the lawyers get a hold of this information with a litiginous family. This will not change until we stop electing lawyers to congress and get real folks in office. Until then, their ideas of reform are cutting payments to doctors and hospitals and expanding the scope of midlevel providers. But no mention of torte reform whatsoever. The whole system is a mess.

 

[dhb]

Think how much money could be saved if we brought back the patient-doctor relationship and removed the lawyers.

I not sure it would be a lot. In Europe where litigation although present is much less prevalent than in the US a lot of MDs will still go all out and practice defensive medicine.

The real problem is MDs are nerds and don't have the balls to do what it take. Just look at how the other thread turned into a discussion about giving a "wooping" dose of 10mg of morphine to a terminal patient. 🙄

 

[michigangirl]

not sure what your post means, dhb. If you would like to write a protocol where all terminal patients get 10 mg of morphine prior to discontinuation of support, feel free. Sorry some of us aren't ballsy enough to use a "one dose fits all" strategy. If I misinterpreted your post, I apologize.

 

[Gern Blansten]

We just had a slightly controversial thread on ICU care. Thought this article was very well written, wanted to share, since it's a slightly different topic but affects all of us. Pay special attention to the 2nd comment after the article by "Linda"

http://zocalopublicsquare.org/thepublicsquare/2011/11/30/how-doctors-die/read/nexus/

Nice article. Very interesting and thought provoking. Thanks for posting.

 

[Surfer]

It would be pretty tragic if you later found out those were the patient's intials.

Or that the patient changed his mind after the tattoo. A tat is not a legal document. I'd have tried to resuscitate, he probably would have died anyway in that scenario.

Don't do anything without legal documentation.

 

[pgg]

Or that the patient changed his mind after the tattoo. A tat is not a legal document. I'd have tried to resuscitate, he probably would have died anyway in that scenario.

Don't do anything without legal documentation.

I wonder if a tattoo with a notary seal and signature would change the legal status ...

(I'd still crack ribs.)

 

[Gern Blansten]

Has anyone ever gone to talk to a patient preoperatively and brought up the fact they they were DNR status and had the patient stare at you in disbelief denying that they had any knowledge of what you were talking about? Looking at this patient and what they were in the hospital for and having surgery for, I have no idea why they would be a DNR status. It was a very awkward discussion trying to explain why their primary had written the order for them to be DNR (they had a bad cancer, but not one that would be expected to be lethal within the next 2-4 years and they led a very active and fulfilling lifestyle). Still no logical explanation even after the discussion with the primary. I was very glad that I had a clear discussion beforehand. It was a low risk surgery, but it would have been tough to explain had something occurred.
It is always better to have had the discussion beforehand rather than guessing as I saw one time when patient wishes were not clarified.

This is how my recent hospitalization played out:
My wife: Doc, I think it is time to let him go be with Jesus.
My doctor: Well, it's just his appendix. Pretty sure we can get him fixed up.
My wife: I don't think he would want that.
My doctor: It's actually a pretty simple surgery. He will be better in no time.
My wife: Quit trying to be a hero and just let him go. It's nature's way.
Me: You know I can hear you, right?
My wife: Dammit!!

 

[dhb]

not sure what your post means, dhb. If you would like to write a protocol where all terminal patients get 10 mg of morphine prior to discontinuation of support, feel free. Sorry some of us aren't ballsy enough to use a "one dose fits all" strategy. If I misinterpreted your post, I apologize.

Oh please, it's just ridiculous imo to be so conservative with the drugs you are giving to someone you've sentenced to death by stopping dialysis/vent/other life maintaining therapies.
Load them up, quick exit, everybody's happy.

 

[Gern Blansten]

Load them up, quick exit, everybody's happy.

nm

 

[dozitgetchahi]

I not sure it would be a lot. In Europe where litigation although present is much less prevalent than in the US a lot of MDs will still go all out and practice defensive medicine.

The real problem is MDs are nerds and don't have the balls to do what it take. Just look at how the other thread turned into a discussion about giving a "wooping" dose of 10mg of morphine to a terminal patient. 🙄

Yes, but many of these countries do indeed have other "sensible" forms of healthcare rationing. For instance, I remember reading that in many European countries dialysis is not available to patients over 65.

 

[UTSouthwestern]

Yes, but many of these countries do indeed have other "sensible" forms of healthcare rationing. For instance, I remember reading that in many European countries dialysis is not available to patients over 65.

Age quotas are some of the least sensible forms of healthcare rationing. For example, my father in law recently passed at 76 after 12 years of dialysis in which he worked productively and volunteered daily at senior centers. Eleven of those years would have been voided in those restricted European countries.

The basis for rationing care has to be approached with a more case by case analysis. By some countries reasoning, I should not be receiving treatment for my stage IV lung cancer because of the magnitude of its spread, but guess what I am and I am still working and being productive and planning big projects for the future.

When it's my time and I know everything's going to the pot, I'll be ready to do what must be done, but until then I'm going to contribute to society in whatever way I can and be a positive, motivating force for all that I can talk to and influence.

 

[dhb]

I remember reading that in many European countries dialysis is not available to patients over 65.

Many is a big exaggeration, in England maybe? but i'm not sure what kind of restriction they have

 

[proman]

Many is a big exaggeration, in England maybe? but i'm not sure what kind of restriction they have

I asked this question to a British cardiac surgeon I worked with. He said there's no restriction of dialysis based on age. Does anyone know different?

 

[dhb]

I think there might be an ICU restriction based on age but i'm not sure. I think there's a lot of urban legends about health care rationing.

 

[pgg]

This article was posted to Slashdot today. Signal-to-noise in the comments is, well, typical for Slashdot, but it's interesting to read how a bunch of laypeople react to it.

http://science.slashdot.org/story/11/12/29/1942237/how-doctors-die

 

[RxBoy]

I think the quickest way to cut healthcare costs is to:

1) Provide free courses to PCP's on how to discuss End of Life issues with patients in an unbiased way.
2) Have a palliative care committee (non government affiliated) that grants these PCPs end of life certification for completing the course.
3) Provide $100 or more reimbursement to every patient the PCP discusses end of life care regardless of the result. If they choose DNR, fill out the paperwork and give them a credit card copy to keep in their wallets.

I think the reason so many of us choose DNR is that we know the horrids of the ICU. All we have to do is teach patients and let them make the informed decisions for themselves.

 

[MTGas2B]

I think the quickest way to cut healthcare costs is to:

1) Provide free courses to PCP's on how to discuss End of Life issues with patients in an unbiased way.
2) Have a palliative care committee (non government affiliated) that grants these PCPs end of life certification for completing the course.
3) Provide $100 or more reimbursement to every patient the PCP discusses end of life care regardless of the result. If they choose DNR, fill out the paperwork and give them a credit card copy to keep in their wallets.

I think the reason so many of us choose DNR is that we know the horrids of the ICU. All we have to do is teach patients and let them make the informed decisions for themselves.

That didn't fly when it was renamed "Death Panel" by its political adversaries. I know a lot of you guys are staunch republicans, but your crew didn't do any of us any favors on that one.

 

[epidural man]

This is how my recent hospitalization played out:
My wife: Doc, I think it is time to let him go be with Jesus.
My doctor: Well, it's just his appendix. Pretty sure we can get him fixed up.
My wife: I don't think he would want that.
My doctor: It's actually a pretty simple surgery. He will be better in no time.
My wife: Quit trying to be a hero and just let him go. It's nature's way.
Me: You know I can hear you, right?
My wife: Dammit!!

seriously...