Monday, October 31, 2011
Agents of Torture
I had multiple admissions to the facility this weekend. Of course, there were the occasional rehab patients recovering from hip and knee replacements. I was shocked, however, to see how many people rolled through our doors with end stage illnesses. The expectation was that they were coming for rehab.
There were metastatic cancers, devastating cerebrovascular accidents, and centenarians newly started on dialysis. As I sorted through the admissions paperwork, I started to see familiar patterns.
Peg tube placed for malnutrition. Dialysis initiated for failing kidneys. Chemotherapy scheduled for lung cancer with diffuse metastases.
Since there was no documentation of detailed end of life discussions, I made a point of asking each patient and family member a few questions:
How do you think treatment is going?
Has anyone told you about prognosis?
What are your goals?
Surprisingly, many of these questions had never been asked or answered. I found my patients and families to be largely oblivious. Many of their responses were shockingly uninformed.
I don't know how we got to this place. I understand that we as a profession need to make money. That gastroenterologists need to place peg tubes, that oncologists need to give chemo, that internists need to rack up visits.
I accept these facts. But when did it become okay to practice futile medicine and batter our patients?
How did we become agents of torture?
Posted by Jordan Grumet at 5:11 AM