tag:blogger.com,1999:blog-1406547525301395071.post5063548442730963598..comments2023-09-19T04:20:38.429-07:00Comments on Status Iatrogenicus: Use Your Own Judgment: The Feckless Physician, the Tyranny of Autonomy, and the Courage of ConvictionsScott K. Aberegg, M.D., M.P.H.http://www.blogger.com/profile/17564774546019869201noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-1406547525301395071.post-11303443369348719382013-07-30T07:46:06.389-07:002013-07-30T07:46:06.389-07:00This is why the nephrologists can be the hero some...This is why the nephrologists can be the hero sometimes. They're one of the few who can (and do) cite futility and refuse to do dialysis. All the other docs circle, wringing their hands, whispering frustrations of futility to each other, but to the family give tepid assessments of harm to the patient. Larry Fordnoreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-38313715768543829482013-07-29T20:40:57.599-07:002013-07-29T20:40:57.599-07:00When is this appearing in the New Yorker?
Great wo...When is this appearing in the New Yorker?<br />Great work.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-76205930810559225442013-07-29T12:39:58.354-07:002013-07-29T12:39:58.354-07:00Keep up the good work! I would love to hear more ...Keep up the good work! I would love to hear more about your takes on current therapies like hypothermia and TPA where the evidence seems pretty mixed.Anonymoushttps://www.blogger.com/profile/06791654657223028320noreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-32207857514546484552013-07-29T10:49:28.859-07:002013-07-29T10:49:28.859-07:00Javad - totally agree with everything you say. Th...Javad - totally agree with everything you say. These decisions cannot be made in the clinic - unless as you note there is a pattern of repeated hospitalizations and declining functional status. My diatribe refers in fact to what I consider the failings of inpatient doctors who have exposure to the patient before I do, when the writing is already on the wall, eg, as you mention, the ER especially, the surgeons, the hospitalists, and indeed some (many?) of my intensivist colleagues.Scott K. Aberegg, M.D., M.P.H.https://www.blogger.com/profile/17564774546019869201noreply@blogger.comtag:blogger.com,1999:blog-1406547525301395071.post-39445367699138760912013-07-29T07:58:43.916-07:002013-07-29T07:58:43.916-07:00We are all educators in this. The term 'docto...We are all educators in this. The term 'doctor' derives from teacher. The belief that this teaching should have occurred earlier is faulty. There is no great time to have this discussion. The clinic is the most time packed and often least likely place for it to occur. Families do not bring in their elderly grandpa for a 'dnr/dni' visit to the clinic in my experience. I have found that the most likely time to do this talk is during an ER visit, a hospitalization or in the ICU. I try to do it before the patient is incapable of having a say in this. I try to tell them that, even though the patient continues to return to their previous level of function, the pattern of repetitive hospitalizations leads me to believe that they are likely in their last year of life and some planning should occur. And I tell them 'if this were my father I would...' And this gives them some freedom from the guilt of making the hard choice to let go. But I think this conversation is more likely to happen in crisis or near-crisis then during the routine and because of that those of us who work in the ER and hospital should be ready to educate whenever the opportunity arises.Anonymoushttps://www.blogger.com/profile/06791654657223028320noreply@blogger.com