Thursday, October 17, 2013

The impact of the decision.

The doctor makes a decision but do they stop and think about the impact? We hope so. But not always.

Here's the story of a 51 year old man who was admitted to the ER with liver and kidney problems. He needed to be stabilized before they could do necessary surgery. Stabilizing was not easy and not even sure that it could be done. He was in intensive care. Two internists stopped by to see him and in less than ten minutes decided what he needed was comfort care and not intensive care. So they moved him out of the ICU and into a regular ward where he died the next day.

What went wrong? Several things but the main one was the decision by the two internists to move him to a general ward for comfort care. A patient with multiple organ failure needs ICU if they are expected to survive. But to the younger interns, perhaps he was an older patient where he was ready for the end of life? But if he had been young, would more effort been made?

Also, was he a terminal patient? Or did he have a terminal disease? Could he have survived with the proper care?

The author concludes with:

"Perhaps what bothers me most is less the fate of our patient than the memory of those two doctors, both so young, efficiently dispatching a complicated decision in a matter of minutes, then dancing off without looking back. They knew a lot about the cost-effective deployment of intensive care. It would have been good to see them spend a little time struggling with the limitations of their analysis."

This is what bothers me - are we raising a new generation of doctors who don't think about the impact of their decision?

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