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.
“...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.
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.
While I agree with you, here in Arizona our patients are routinely informed (recommended) that their DNR status is suspended for a specific procedure, eg Cardiac Catheterization/Stent/Balloon Angioplasty. The suspension is noted on the consent. When a guidewire wiggles into the LV and the patient goes into Vtac/fib due to our intervention we will defibrilate them. There are rare cases of chest compressions. We just know we are working with a sick heart at the beginning and try to prep for the worst.
Good post...........
Funny...gas dr..!!! Ha!!
Thanks for confirming my post at #19.
Great post...I can relate.