Posted on 03/28/2018 2:41:40 PM PDT by Twotone
Patients beware. When you’re admitted to a hospital, you’re routinely encouraged to sign a DNR, short for Do Not Resuscitate order. Don’t assume it will apply only in extreme circumstances. New research shows having those three letters — DNR — on your chart could put you on course to getting less medical and nursing care throughout your stay. Fewer MRIs and CT scans, fewer medications, even fewer bedside visits from doctors. A DNR could cost you your life.
They even hesitate to put DNR patients in the ICU when they need intensive care.
No wonder patients with DNRs have far worse recovery rates than patients with identical conditions and no DNRs. Women are especially affected.
Hip fracture surgery patients who opt for DNRs reduce their chances of surviving their hospital stay. At Brigham and Women’s Hospital in Boston, researchers found that “mortality was over two times greater” for patients with DNRs than those without them.
DNR means if your heart stops or you can’t breathe, medical staff will let you die naturally, instead of rushing to give you cardiopulmonary resuscitation. Correctly interpreted, a DNR bars just that one procedure, resuscitation. But scientists are discovering that many doctors and nurses take DNR to mean you want end-of-life care only. They misconstrue DNR as Dying Not Recovering.
(Excerpt) Read more at spectator.org ...
“The doctor told me that the paramedics would break the bones in his chest and Dad would die in pain.”
That’s what I’ve read by doctors who declined to initiate a DNR. However, I wonder about how many paramedics respect a DNR during the process of life saving. Probably zero to none.
CPR for all other conditions causing death in a hospital (cancer, AIDS, GI bleeding, etc) has very poor results and should not be the norm. I mean, think about it.
If your heart stops because cancer has invaded your chest and choked off blood return, or because treatment for your AIDS pneumonia has failed, or because you've bled out despite two big IV lines and 8 units of blood on pumps, CPR is a bizarre and unpleasant ritual with no possibility of success.
In almost all cases, this decision is easy for a patient's real doctor, if he/she has one.
I have a copy of the letter of thanks sent to my step father from the elderly gentleman who received his heart.............
I've always wanted to contact the gentleman to see how he is doing but privacy laws prevent the organization that administers these things from releasing his information........I hope he is still alive.
My only choice, if they force me to go to ground temperature, is for my family to call Willow, Xanda, Anya, and Tara...They'll know how to get me back...
Why Your Doctor Probably Has a “Do Not Resuscitate” Order
http://time.com/131443/why-your-doctor-probably-has-a-do-not-resuscitate-order/
A DNR is usually discussed when the patients health problems mount to the point that where continuing treatment will just basically prolong the suffering.
In Texas at least, any person on scene can revoke the DNR, even against the patient’s wishes, by just saying “work them.”
In 30 yrs, I have never encountered a DNR that didn’t appear to be based on an informed decision.
I have been told that signing for donating your organs narrows down your survival rate.
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Organ Donor is noted on Colorado driver’s Licenses.
CPR is given to those who have no pulse, not breathing. If you have no pulse and not breathing then you are basically dead. Dead people basically do not feel pain.
As it turns out, in order to survive VF, VT, you need high quality CPR immediately and defibrillation very soon after. Even then chances of survival are small but still there is a chance. You have 4 minutes after arrest before permanent brain damage.
Patients that are asystole have no shockable rhythm, hence an AED will not advise a shock but to continue compressions. Where it is pointless and in my opinion abuse of a corpse is when either there are conditions inconsistent with life or if the patient has been involved in a unwitnessed arrest.
If EMS gets involved, they by protocol, have to do compressions if the family asks or if someone has already started CPR before they get on scene. In order to discontinue medics in the field need permission from the medical command doctor at a receiving hospital or if again there are conditions inconsistent with life. But in that case they still must report to medical command and depending on the situation ask the 911 dispatching authority to dispatch the coroner.
It just so happens that I responded to (an EMS Assist) as a firefighter last weekend, the family wanted us to do CPR, the patient was in rigor which is a sign inconsistent with life, so no CPR. Still, stress galore.
I have had the opportunity to perform CPR roughly a dozen times on patients that could benefit from it. (I’m a volley Firefighter/EMT). I have had patients twice return to a viable rhythm, one was a drowning the patient that lived for 2 weeks but was in a coma, the other (lightning strike) lasted 12 hours. We did compressions for about 2 hours on that one, at the scene, in the truck and in the ER. Still in both cases the family was able to say goodbye.
Having said all that it is up to the individual and/or family regarding a DNR. If I had a week to live then I don’t want to put anyone trough the stress of having to do CPR. It is, even for healthcare workers, very stressful. CPR BTW, performed on a human being is not the same as CPR on a practice dummy.
I don’t know the person that wrote this article but I have worked at a hospital for nearly 38 years and to say that “you are routinely encouraged to sign a DNR” is probably one big, fat LIE.
People that have dedicated their life to healthcare do NOT routinely encourage people to kill themselves. I know better than this.
Are DNRs discussed, yes, we’re required to by our ever intrusive overlords (there are many different kinds of them - not just the federal gov’t). Are people “routinely encouraged to sign a DNR” ...... bullshit.
Interesting.
Our medical systems up here and doctors are all pushing DNRs and living wills.
I recall hearing that our Thymus Gland is like Cocaine to Them.
“Betsy McCaughey, Ph.D., is a patient advocate, chairman and founder of the Committee to Reduce Infection Deaths, and a former Lt. Governor of New York State.”
Betsy McCaughey is very well-regarded, & many of her articles have been posted on FR. She’s really gone after the problems with Obamacare. While all situations are not applicable across the board & at all hospitals, I think she knows where-of she speaks.
I don’t know the person that wrote this article but I have worked at a hospital for nearly 38 years and to say that “you are routinely encouraged to sign a DNR” is probably one big, fat LIE.
People that have dedicated their life to healthcare do NOT routinely encourage people to kill themselves. I know better than this.
Are DNRs discussed, yes, we’re required to by our ever intrusive overlords (there are many different kinds of them - not just the federal gov’t). Are people “routinely encouraged to sign a DNR” ...... bullshit.
Additionally, if someone wants to simply be made comfortable we initiate comfort measure only orders. That is when we withhold antibiotics, medication etc because death is coming. Often this is for cancer patients or other end of life patients. More often than not we won’t initiate dialysis and this is often what allows a natural and pleasant end of life supplemented with appropriate pain control.
The comment on the hip fracture is pure BS. If you have surgery ALL DNR orders are suspended becuase what I do as an anesthesiologist is essentially a resuscitation and life support. If you consent to surgery you consent to full life saving measures as a condition of surgery. DNR only is reinstituted once the perioperative period and recovery ends.
No ethical physician would not care for a DNR patient and give the absolute best. As for me as an intensivist my loved ones know (my sister who is a physician) knows that I do not want my death artificially prolonged in painful and awful ways including long term ventilation so I can get bed sores and multiple rounds or infection. I know heaven awaits me
What patients SHOJLD worry about however is the pressure that non-clinical administrators who run hospitals put o. Physicians to reduce length of stay. I have had administrators in my career suggest I should have a comfort care only discussion based on length of stay. This particular administrator was the Chief Financial Officer of a large for profit hospital chain. Needless to say the answer he received was not what he expected of the chief medical officer of the same hospital which I was at the time.
Sadly most hospital based physicians are becoming employees of large groups and evaluated based on metrics that have to do with things like length of stay, reduction of cost, and require double checks from administrators on testing and lab. Please do not hesitate to look up such companies as Envision, Teamhealth, Intensive Care Consortiim and their websites. If you look far enough you will find the main thrust is reducing costs not patient care. Caveat Emptor sadly now applies to healthcare.
How dare you opine that someone with no heartbeat and respiration is basically dead and therefore does not feel pain. With all due respect your statement is dangerous and backed by minimal understanding of human physiology. I can point to thousands of patients whom I have resuscitated over my career who felt great pain and fear in advanced cardiac life support. I will gladly put this up against your dozen resuscitations. May I remind you of the great advice that it is better to be silent and thought a fool than to speak and remove all doubt.
What does it mean?
“...researchers found that “mortality was over two times greater” for patients with DNRs than those without them. For the healthiest patients, the impact was even more extreme. DNRs upped their risk of dying in the hospital from 3% to 17% — a five-fold increase.”
Regardless of your personal experience, or your expertise as a board certified anesthesiologist, the author is referring to research studies. The statistics may not apply in your experience or to your hospital in general, but apparently there IS an issue with DNR’s & it behooves all of us to know the possible consequences of signing such documents when we have no idea who is going to be making decisions based on what they think we want.
Never met one. I would suspect most of the “bad ones” would come the liberal side of the medical community (the AMA, for example) - and as cranky as our ED MDs are, they are personally righteous men and women - or as righteous as mankind is ....
There is a huge difference between “informing” and “encouraging”. Same is true of “facts” and “embellishments”. There is also a gigantic gulf between “routinely’ and ‘pockets’ of this. The culture of a hospital is not different than the culture of any other organization - some hospitals suck - most don’t.
While we’re on it - this came from “research” and I have no idea the agenda of those that did the “research”. I have very little patience for hype and “authors” trying to get attention - my experience, 38 years, is 180 degrees from the claims of this hack.
We've had different experiences, I dare say.
Outside of the surgical/critical care world, what's your experience with CPR?
With patients found dead when the nurses make 5:30 AM rounds, for example? Or bleeders who go asystolic when the blood comes out faster than you can put it in?
It's a serious issue. New York State mandates CPR unless declined in writing as a "pro-life" measure, but most of MY patients who arrest do so because everything done to prevent it has failed.
Acute MIs? Absolutely yes. End of life CMO people who signed the paper? Absolutely not.
People who die overnight in an unmonitored bed with cancer, AIDS, cirrhosis and liver failure?
Them, I'm not so sure it should be a requirement.
I've done it, and not done it, a lot since July 1, 1974. I think the current regulatory and legal environment promotes "slow codes" when "no codes" sould be at the doctor's discretion based on circumstances in the moment.
When I was a senior on call, I used to carry an ophthalmoscope for exactly this reason. Fixed, dilated, blood clotted in retinal veins? No code.
Which is, IMO, as it should be.
In a neighboring town are two hospitals. One which does as you suggest and treat and provide the utmost care. The second hospital is not worthy of the name. It’s where you go if you want to die. Not all hospitals are alike and ran like yours.
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