I actually subscribed to epoch times to read this. I was curious as to the actual facts.
Thirst let me say this is a heart wrenching article. Some of it written for effect. Some of it with some assumptions and inaccuracies. Some of it problematic.
The first thing it the DNR. DNR does not mean do not treat. Withdrawal of support and consider measures is when life support is compassionately weaned. I take care of a lot of people DNR and provide the full scope of care. All this designation means is if there is cardiac arrest ACLS is not initiated.
Secondly it is patently false that when admitted we test you for COVID until positive then start you on sedatives. This does not happen and is a fiction that just ain’t true. The family states package inserts for morphine say do not five with benzos or dex. This is untrue and well. It says do not give without immediate respiratory support available. If we can’t give certain combinations of medications we can’t anesthetize patients for surgery. The black box warning is about respiratory depression where there is no help available. Benzos are avoided in the hospital because of the association of acute delirium. For full details look up CAM ICU and RASS scores. In the bad old days we used to snow people on the vent. We now know this is not right and to trade all medications to a goal RASS of -1 or 0.
Next there is not one physician looking to put someone on a vent. We do not use blood pressure to determine that nor heart rate. We generally do not use isolated pulse ox either. We use ABGs in concert overall clinical picture to determine if vent support is necessary.
As for the DNR it is not clear who had the power to speak for this. If the patient was not DNR then there is a tort here that should be filed. However this article paints a murky picture as to where and why the DNR was proffered. I make sure that I have a fully understanding of every patients wish on admission through conversation with the patient or whom by law can speak for them. We are required to record the code status immediately so we may direct care.
As for protocols, i still laugh when I feel of these. ICDM is just a large book of diagnosis codes. It does not have anything to do with treatment. To this day I have not been required to treat anyone in any particular way. As a licensee to practice medicine i am granted independent judgment and can treat patients as I see fit.
There most definitely should be an investigation into some allegations here that are legitimate. But there is an awful lot of information that is not pertinent to the actual situation. It is in the misapplication of statements that I find some loss of credibility on this article
But the one thing that is clear. Physicians do a very poor job of clearly communicating with families. It is the number one complaint I hear in performance improvement committees. I agree that this is an easy thing we could do to correct a lot of misconceptions and trust breaches we in medicine have created. Every family and every patient I treat gets time with me on admission so I can explain what I am seeing and what to expect. Sadly, because we do not communicate well and answer questions,
There are valid criticisms of the health care system. But there is another side to this story. There are questions that need to be answered.
It is unfortunate the healthcare profession has squandered any goodwill it carried.
Unless someone knows and trusts their healthcare team, it should be assumed they are not acting in the patient’s interest until they can prove otherwise.
It was breathtaking to watch how quickly bioethics such as patient choice and abhorrence of coercion were tossed to the curb for power and money.
Thank you for the thoughtful reply. Yeah I find Epoch Times articles hard to read. They really are all over the place.
If you give the full scope of care even with a DNR, I’d want you as a physician. It really hasn’t been my experience with others.
First let me say I’ve been holding a medical POA for an elderly relative with dementia for many years. The obvious comtempt some physicians have for treating this man has certainly left me jaded. Nevertheless even the last hospital attending who told me she never wanted to see him in her ward again treated him well enough that he made a dramatic turnaround.
It’s been my impression that code status simply is a guideline. How far to go in treatment. And yes I’ve had physicians tell me that code status determines treatment. It stops “extraordinary” treament which sounds reasonable until you find out fluid IVs are extraordinary to some physicians.
AFA this particular story. The DNR according to the hospital is responsible for the hospital not treating a girl who was young and whose parents wanted her full code. The first thing I wondered is if they signed a living will for her. I will say other hospitals have used DNRs to refuse treatment for fatal overdoses which happened in the case I posted about in a prior post.