One of the most difficult decisions for a doctor is whether to let a very sick patient die if the heart stops, or to try resuscitation. A new survey in The Western Journal of Medicine finds that doctors find it difficult to discuss the matter with their patients.
One physician told the journal that it's a matter of "explaining to the patient what you want and getting the patient to ask for what you want."
Among the 15 doctors asked to simulate how they would discuss "do-not-resuscitate" orders with their patients, there were wide differences in the words and details used, the journal reports. Some described the difficult resuscitation procedures in detail, using phrases like "big intravenous lines" and "oxygen exchange"; others were more vague, describing the resuscitation as a "heroic" measure using "sophisticated" techniques.
"I have two biases," one physician told the journal. "One is that the patient needs to be the one to make the decision . . .
"But . . . if there is no hope, then I don't feel I am obligated to treat in a hopeless situation. And I'll usually let the patient override that, if the patient is with it. But I'd rather the patient agree to a 'no code' a do-not-resuscitate order .
"I try not to make my opinion known . . . but I think I may bias it by making [resuscitation] sound as gruesome as it really is. I wouldn't want my wife or parent to have it."