Friday, July 2, 2010
Do the words 'doctor's orders' mean anything anymore?
Why don't people believe their doctors anymore? Studies show that families of critical patients are likely to have more optimistic outlook on a loved one's chance of survival no matter how the doctor delivers the bad news. A study looked at doctors using qualitative phrases, such as "unlikely" chances of survival, compared to quantitative phrases, such as "10% chance" of surviving. Family members kept their hopes up either way.
Yesterday, we reported that patients didn't understand or accept evidence-based medicine. Now, they don't accept their doctor's best advice in end-of-life decisions. But all is not lost. Doctors can still successfully help patients at the end of life and their families through paperwork.
Documenting end-of-life treatment decisions as doctor's medical orders in nursing homes resulted in patients getting the care they wanted and fewer unwanted hospitalizations and interventions, according to a study of 1,711 patients that appeared in the Journal of the American Geriatrics Society.
The orders, documented as Physicians Orders for Life Sustaining Treatment (POLST), resulted in nursing home residents more often having orders about life-sustaining treatment preferences than residents who didn't (98.0% vs 16.1%, P<.001). Residents with POLST forms for comfort measures only were less likely to receive medical interventions than residents with full treatment orders (P=.004), traditional do-not-resuscitate orders (P<.001) or traditional full code orders (P<.001).
Researchers explained that POLST is more than just paperwork, but is the nexus for a system-wide understanding of patients' wishes that is kept with the patient instead of being filed away. ACP Hospitalist outlines how it works.
Labels: end of life, hospital medicine, patient communication
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Send comments to ACP Hospitalist staff at acphospitalist@acponline.org.
Previous Posts
- 'Fame' doesn't translate into quality care
- Push or pull?
- Life at Grady: Talkin 'bout my generation gap
- The never events that always happen
- Life at Grady: A clinician-educator reflects
- Life at Grady: Ready-ta-go
- Take two aspirin but don't call me when you really...
- An admission that inpatient care is needed
- More details that no one read.
- Talking about readmissions
Blog log
Members of the American College of Physicians contribute posts from their own sites to ACP Internist and ACP Hospitalist. Contributors include:
Albert
Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the
University of California, Los Angeles School of Medicine, where he
also did his internal medicine training. Certified by the American
Board of Internal Medicine, Dr. Fuchs spent three years as a
full-time faculty member at UCLA School of Medicine before opening
his private practice in Beverly Hills in 2000.
Zackary
Berger
Zackary Berger, MD, ACP Member, is a primary care
doctor and general internist in the Division of General Internal
Medicine at Johns Hopkins. His research interests include
doctor-patient communication, bioethics, and systematic reviews.
CasesBlog
Ves
Dimov, MD, ACP Member, is an allergist/immunologist and Assistant
Professor of Medicine and Pediatrics at the University of Chicago,
where he evaluates and treats both pediatric and adult patients.
David
Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally
renowned authority on nutrition, weight management, and the
prevention of chronic disease, and an internationally recognized
leader in integrative medicine and patient-centered care.
db's
Medical Rants
Robert M. Centor, MD, FACP,
contributes short essays contemplating medicine and the health care
system.
DrDialogue
Juliet
K. Mavromatis, MD, FACP, provides a conversation about health topics
for patients and health professionals.
Dr.
Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal
medicine for more than a decade and is an Associate Professor of
Medicine at an academic medical center on the East Coast. His time is
split between teaching medical students and residents, and caring for
patients.
Everything
Health
Toni Brayer, MD, FACP, blogs about the rapid
changes in science, medicine, health and healing in the 21st century.
FutureDocs
Vineet
Arora, MD, FACP, is Associate Program Director for the Internal
Medicine Residency and Assistant Dean of Scholarship & Discovery
at the Pritzker School of Medicine for the University of Chicago. Her
education and research focus is on resident duty hours, patient
handoffs, medical professionalism, and quality of hospital care. She
is also an academic hospitalist.
Glass
Hospital
John H. Schumann, MD, FACP, provides
transparency on the workings of medical practice and the complexities
of hospital care, illuminates the emotional and cognitive aspects of
caregiving and decision-making from the perspective of an active
primary care physician, and offers behind-the-scenes portraits of
hospital sanctums and the people who inhabit them.
Gut
Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist
at the University of North Carolina School of Medicine, and the
Program Director for the GI & Hepatology Fellowship Program. He
specializes in diseases of the esophagus, with a strong interest in
the diagnosis and treatment of patients who have difficult-to-manage
esophageal problems such as refractory GERD, heartburn, and chest
pain.
I'm
dok
ACP Member Mike Aref, MD, PhD, ACP Member, is an academic
hospitalist with an interest in basic and clinical science and
education, with interests in noninvasive monitoring and diagnostic
testing using novel bedside imaging modalities, diagnostic reasoning,
medical informatics, new medical education modalities, pre-code/code
management, palliative care, patient-physician communication, quality
improvement, and quantitative biomedical imaging.
Informatics
Professor
William Hersh, MD, FACP, Professor and Chair,
Department of Medical Informatics & Clinical Epidemiology, Oregon
Health & Science University, posts his thoughts on various topics
related to biomedical and health informatics.
Just
Oncology
Richard Just, MD, ACP Member, has 36 years in
clinical practice of hematology and medical oncology. His blog is a
joint publication with Gregg Masters, MPH.
KevinMD
Kevin
Pho, MD, ACP Member, offers one of the Web's definitive sites for
influential health commentary.
MD
Whistleblower
Michael Kirsch, MD, FACP, addresses
the joys and challenges of medical practice, including controversies
in the doctor-patient relationship, medical ethics and measuring
medical quality. When he's not writing, he's performing
colonoscopies.
Medical
Lessons
Elaine Schattner, MD, ACP Member, shares
her ideas on education, ethics in medicine, health care news and
culture. Her views on medicine are informed by her past experiences
in caring for patients, as a researcher in cancer immunology, and as
a patient who's had breast cancer.
More
Musings
Rob Lamberts, MD, ACP Member, a med-peds and general
practice internist, returns with "volume 2" of his personal
musings about medicine, life, armadillos and Sasquatch at More
Musings (of a Distractible Kind).
Musing
of an Internist
Justin Penn, MD, ACP Associate Member,
attended medical school at the University of Washington School of
Medicine and trained in internal medicine at the University of
Rochester, where he is serving as Chief Resident.
Prescriptions
David
M. Sack, MD, FACP, practices general gastroenterology at a small
community hospital in Connecticut. His blog is a series of musings on
medicine, medical care, the health care system and medical ethics, in
no particular order.
Reflections
of a Grady Doctor
Kimberly Manning, MD, FACP,
reflects on the personal side of being a doctor in a community
hospital in Atlanta.
Technology
in (Medical) Education
Neil Mehta, MBBS, MS, FACP,
is interested in use of technology in education, social media and
networking, practice management and evidence-based medicine tools,
personal information and knowledge management.
White
Coat Underground
Peter A. Lipson, MD, ACP Member, is a
practicing internist and teaching physician in Southeast Michigan.
The blog, which has been around in various forms since 2007, offers
musings on the intersection of science, medicine, and culture.
Other blogs of note:
American
Journal of Medicine
Also known as the Green
Journal, the American Journal of Medicine publishes original clinical
articles of interest to physicians in internal medicine and its
subspecialities, both in academia and community-based practice.
Clinical
Correlations
A collaborative medical blog started
by Neil Shapiro, MD, ACP Member, associate program director at New
York University Medical Center's internal medicine residency program.
Faculty, residents and students contribute case studies, mystery
quizzes, news, commentary and more.
Interact
MD
Michael Benjamin, MD, ACP member, doesn't accept
industry money so he can create an independent, clinician-reviewed
space on the Internet for physicians to report and comment on the
medical news of the day.
PLoS
Blog
The Public Library of Science's open access
materials include a blog.
White
Coat Rants
One of the most popular anonymous blogs
written by an emergency room physician.

1 Comments:
"Now, they don't accept their doctor's best advice in end-of-life decisions. "
This is a very interesting topic and one that I have been considering a great deal lately - after seeing many patients at the end-of-life come into the hospital - already having died peacefully - only to be assaulted by the process of CPR. I wonder if it is that patients are not accepting what physicians are saying, or if physicians are skirting around the issue of end-of-life, or if we simply need to change our tactics as physicians in order to promote a dialogue between patients and their families about their goals for end of life care. I have a recent blog entry at http://idiopathicmedicine.wordpress.com/2010/06/11/cmo/. Please check it out. Excellent entry!
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