Comments on: The Man on the Table Devised the Surgery http://www.kevinmd.com/blog/2006/12/man-on-table-devised-surgery.html Tue, 14 Feb 2012 17:18:00 +0000 hourly 1 By: John J. Coupalhttp://www.kevinmd.com/blog/2006/12/man-on-table-devised-surgery.html#comment-69900 John J. Coupal Wed, 27 Dec 2006 20:20:00 +0000 http://clients.emmense.com/kevinmd/2006/12/the-man-on-the-table-devised-the-surgery.html#comment-69900 Nothing like an insistent wife to get decision-making off dead center! Nothing like an insistent wife to get decision-making off dead center!

]]> By: Gasmanhttp://www.kevinmd.com/blog/2006/12/man-on-table-devised-surgery.html#comment-69888 Gasman Tue, 26 Dec 2006 21:51:00 +0000 http://clients.emmense.com/kevinmd/2006/12/the-man-on-the-table-devised-the-surgery.html#comment-69888 Understanding the patient's intent is the purpose of the ethics committee meeting here. There were some statements early in the NYT article about how the patient was extremely hesitant to proceed with surgery because he knew (perhaps the best informed patient as ever could be) that the probabilities of languishing in an undesired state were quite substantial. Further, his very actions of delaying the surgery and attempting medical management for months further solidified understanding such a 'do not operate' wish of the patient; that is he would not wait and see if his aorta would blow up if he intended the surgical option. <br/><br/>The final line in the article tells exactly why an ethics committee meeting was required. The patient's surgeons felt that the purpose of such a group, to reach consensus of the medical team, was superfluous and that the surgeons alone could and should make such decisions. But surgeons have long ago ceased to be the only physician on the team. Those most immediately involved would be the intensivist (never mentioned in the article), cardiologist, and anesthesiologist as those who would be responsible for the patient's care. It is precisely because so many are responsible for managing the patient that it is no longer appropriate for a surgeon alone to divine the patient's desires and dictate all treatment goals. Understanding the patient’s intent is the purpose of the ethics committee meeting here. There were some statements early in the NYT article about how the patient was extremely hesitant to proceed with surgery because he knew (perhaps the best informed patient as ever could be) that the probabilities of languishing in an undesired state were quite substantial. Further, his very actions of delaying the surgery and attempting medical management for months further solidified understanding such a ‘do not operate’ wish of the patient; that is he would not wait and see if his aorta would blow up if he intended the surgical option.

The final line in the article tells exactly why an ethics committee meeting was required. The patient’s surgeons felt that the purpose of such a group, to reach consensus of the medical team, was superfluous and that the surgeons alone could and should make such decisions. But surgeons have long ago ceased to be the only physician on the team. Those most immediately involved would be the intensivist (never mentioned in the article), cardiologist, and anesthesiologist as those who would be responsible for the patient’s care. It is precisely because so many are responsible for managing the patient that it is no longer appropriate for a surgeon alone to divine the patient’s desires and dictate all treatment goals.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/12/man-on-table-devised-surgery.html#comment-69883 Anonymous Tue, 26 Dec 2006 18:28:00 +0000 http://clients.emmense.com/kevinmd/2006/12/the-man-on-the-table-devised-the-surgery.html#comment-69883 The idiotic part of the whole process was the idiots in the ethics committee arguing about whether or not a DNR meant that the surgery should not take place. The last time I checked, type 2 dissecting aortic aneurysm repair was not resuscitation. The patient advocate at my hospital has gotten so incensed about DNRs being read like this that the advocates office sends someone down to look in on each ICU admit and each request for a DNR in order to explicitly document what non-resuscitative care is desired (generally our pts want everything short of the crash cart, contrary to what many house staff seem to think the DNR means) The idiotic part of the whole process was the idiots in the ethics committee arguing about whether or not a DNR meant that the surgery should not take place. The last time I checked, type 2 dissecting aortic aneurysm repair was not resuscitation. The patient advocate at my hospital has gotten so incensed about DNRs being read like this that the advocates office sends someone down to look in on each ICU admit and each request for a DNR in order to explicitly document what non-resuscitative care is desired (generally our pts want everything short of the crash cart, contrary to what many house staff seem to think the DNR means)

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