Friday, November 29, 2013

I've deduced their fiendish plot!

By getting families into mashed-potato-flinging arguments over divisive political topics at the Thanksgiving table, the government was hoping you'd stop speaking to your folks and come crash on its sofa.
Posted by @
Labels: ,

5 comments:

JohninMd(help?) said...

As I said to X, Ya gotta wonder how many SWAT deployments yesterday could be blamed on Mooshelle's ACA "discussions" around the table....

10:52 AM, November 29, 2013
Keith said...

The NRA botched their response to this by making thanksgiving crap of their own rather than simply dismissing it as inappropriate. Way to go guys.

10:59 AM, November 29, 2013
Anonymous said...

On a more serious note, I do wish that more families would talk about one aspect of health care: advance directives. As an EMT, I've been on calls where there was no agreement on what the patient or family wanted, and/or no supporting documentation. It's a bad scene where everybody loses.

If someone you love is at the point where they don't want folks jumping on their chest or stuffing tubes down their throats, make sure everybody knows it and that they have whatever DNR paperwork their state requires.

11:04 AM, November 29, 2013
staghounds said...

Word, Anonymous. The gift of easy death has to be given in advance, and it's free.

11:52 AM, November 29, 2013
Mike_C said...

Anonymous @11:04 has it absolutely right (though DNR/DNI is not exactly holiday-dinner conversation). Having advance directives in place is very important, and in my opinion is something that is best done in consultation with the primary care provider (PCP, be it general a Internal Medicine or Family Practice MD, or NP or PA -- the degree matters less than that the PCP knows you and that you are comfortable with him or her). If god forbid a family member is struggling with cancer, note that oncologists, as a subspecialty, are notoriously bad about the advance directives talk ("I didn't want to take away hope ..." is the usual excuse for failing to have a realistic talk with the patient and his/her family.) As a cardiologist I no longer deal much with cancer (except in the case of people whose hearts have been damaged by chemotherapy agents), so I have no dog in that fight, but the above is based on sad experiences during medical school and years of training.

Another couple points:
1. Physicians are often not well trained in the "code status" talk, and it's particularly not done well under stressful inpatient (hospital) conditions. Have the talk early with the PCP. If a hospital doctor asks something like "Do you want us to do everything or just let nature take its course" then that doctor is sloppy or an idiot. We NEVER just walk out the door and let the patient die in agony and the code talk should never imply that. Code status refers to whether "extraordinary measures" (intubation and respirator, CPR, electrical shocks, etc) are to be permitted by the patient, and it never means withholding medications for controlling pain or anxiety or other routine care.
2. The code status thing is a package deal. Sometimes I see med students or interns present it as a smorgasbord. "Would you want to be intubated? Would you want to be on a respirator? Would you want CPR (chest compressions)? How about an electrical shock?" It's not a Chinese menu with one item from column A, another from column B and if you order two entrees then free crab rangoon. It's a package deal. Intubation but no ventillator (breathing machine), for example, is moronic. Is someone going to use an ambu-bag (that manual push-air thing that looks like a football) for the rest of the hospital stay? Talk to your PCP and get things squared away. Also, designate a patient advocate, and ideally also have that person be the durable medical power of attorney. Legal status, baby!

Finally, if one is put into the role of deciding code status (for a family member no longer able to decide or communicate his/her wishes), know that it is never easy, and selecting DNR/DNI (after consultation with physicians, other family members -- and clergy if you're into that sort of thing -- but always bearing in mind that the advocate's job is to try and deduce and convey what the patient would have wanted, not necessarily what the advocate personally, uncle Bob or even Pastor Smith wants) does NOT mean that you're letting the patient down. It takes great moral courage to select DNR/DNI on someone else's behalf. It is MUCH easier to say "do everything possible" but sometimes "do everything" is not only no kindness, but vile cruelty.

9:52 PM, November 29, 2013

Post a Comment

Subscribe to: Post Comments (Atom)