It's only been two days since my last post on
prognosis and end-of-life care in the ICU, and I'm anxious to blog about today's NEJM article on low tidal volume in the operating room on the
Medical Evidence Blog, but the happenings around me already today mandate another post about realistic prognostication and it's effective communication.
When I make an assessment of a patient in the ICU, my list of summary conditions and conclusions often looks something like this:
ASSESSMENT:
- Advanced age
- Poor Functional Status
- Malnutrition/Cachexia
- Swallowing dysfunction
- S/P fall and hip fracture
- Aspiration pneumonia
- Congestive Heart Failure
- Respiratory failure
- Renal failure
- Poor Prognosis for both survival and return to independent livinng
This is not the norm. The norm is to methodically list all of the acute and chronic medicalized and pathophysiologically interesting diagnoses. In that vein, obvious things that can't be traced to a medically interesting and well delineated disease cascade are left out (such as advanced age and poor functional status.)
