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Research Shows Some Misunderstanding Among Physicians Regarding End-Of-Life Directives

Struggling with the meaning of life is one thing. Struggling with the meaning of end-of-life directives shouldn’t be.

Physicians misidentify living wills as do-not-resuscitate (DNR) designations and DNR orders as end-of-life care directives, concluded a study. Adding code status designations to a standard advanced directive can ensure that patients receive or do not receive the care they want.

The study, “TRIAD III: Nationwide Assessment of Living Wills and Do Not Resuscitate Orders,” appeared in the Dec. 5 issue of The Journal of Emergency Medicine.

Researchers Read more »

*This blog post was originally published at ACP Hospitalist*

When “Doing Fine” Is Relative

It was 11:00 pm when the pager vibrated, then beeped: it was the ER, Hospital #3.

“This is Dr. Fisher returning your page?”

“Thank you Dr. Fisher, just a moment for Dr. Frigamafratz.”

A brief pause, then:

“Wes, I think we’ll need your services. Old guy, found down at the nursing home, brought in unconscious, pulse 25 – hooked him up to an external pacer, he’s back with us now.”

“I’m on my way.”

When I arrived, there was the usual cacophony of activity in the Emergency Room. Someone screaming in one corner. Intercom sounding. Ambulance en route to our location. Breathing treatments underway in Bay 5. Room 10 headed to the CT scanner. Has room 12 got a bed? By comparison my patient was easy: his disposition in the eyes of the ER staff had been made: he was on the Express Track to the EP lab.

There he was, chest twitching. Big forceful jerking. He was a big guy, uttering something with purpose but impossible to understand. Next to him, his wife, just arriving and removing her coat. “Is he going to be okay?”

My head scrambled for an answer. “He’s okay for now,” I think I replied. Read more »

*This blog post was originally published at Dr. Wes*

End-Of-Life Wishes: How To “Engage With Grace”

As patients, as family members, as friends, as health care providers, we have all faced end-of-life issues at one time or another, and we will face them again. And again. 

This weekend the “Engage With Grace” message is being broadcast virally, through a “blog rally,” at a time when many people are with family and friends over the long weekend. The point is: We all need to have the potentially uncomfortable conversation with people close to us about what kind of treatment we would want, and they would want, if incapable of making or communicating healthcare decisions. CNN ran a story on “Engage With Grace” yesterday.

End-of-life decision-making has long been an issue of great personal and professional interest to me, and I am proud to have played a role in having out-of-hospital DNR orders recognized in Massachusetts by EMS providers, as an example. Read more »

*This blog post was originally published at HealthBlawg :: David Harlow's Health Care Law Blog*

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