We have to do better than DNR tattoos

Returning from my week of vacation, I was greeted by the usual stack of mail, faxes, forms to be signed, throwaway journals, and a fully loaded group of in-basket messages that had piled up in the electronic medical record that needed attending to.

One of the pieces of mail was an unsolicited package with a bright red label on it, along with multiple very medical-looking symbols including red crosses and caducei. “Medical ID’s Save Lives!”

Inside was a promotional packet that turned into one of those free-standing containers that they requested we open and assemble and place in a prominent location in our practice. It included some examples of the medical ID bracelets and pendants that this company prepares for patients, listing medical conditions, allergies, emergency contacts, and the like, along with a price list and application forms.

As I started to toss this in the trash (we don’t leave any promotional or advertising materials around our practice, nor do we let drug reps in to talk to our faculty or residents), it made me wonder whether these things really do save lives.

There are probably countless examples out there where a bystander or paramedics have come across an unconscious person on the street, noticed their silver bracelet that said they were a type I diabetic, and quickly delivered appropriate life-saving treatment. Similarly, the notation of someone’s allergies could prevent devastating reactions in the emergency room, and also make the team trying to figure out what’s happening to a patient think about a possible anaphylactic allergic reaction to medication the patient may have already received. All of this is dependent on someone noticing the bracelet, and getting to it in a timely fashion — the right information to the right people at the right time.

A tattoo to remember

I remember the first time I saw a DNR tattoo emblazoned across a patient’s chest. She was, in fact, not in need of resuscitation, but sitting upright on the exam table in the office for her initial visit checkup. It generated a really interesting discussion about how she had friends who had been resuscitated against their wishes, and family members who suffered unnecessarily in the hospital, and had been so moved to not only make herself DNR, but to permanently and proudly display this on her body.

Since then, I’ve seen multiple different iterations of this, ranging from subtle tattoos on people’s wrists and chests and necks, to huge multicolored calligraphy banners shouting out their intentions about life and the choices they’re making. One patient I met in the emergency room during residency had big red stop signs tattooed across all potential central line access points, including his jugular, subclavian, and femoral veins, in addition to the DNR tattoo on his chest.

Of course this always generates questions as to whether these tattoos are legal documents, and I’ve heard arguments both ways as to whether they should be respected (was the tattoo a joke or the result of a drunken dare; was the patient driving back to the tattoo parlor to get it removed when they were in the motor vehicle accident that left them in this state; or, how can a piece of paper be more official that what I permanently inked on my body – you believed me when I wrote “I love Mom”?).

All the info in one place

Just recently, when we were admitting a patient to the hospital from our office, the resident told me that the patient had told her that he was DNR, and that this was his long-standing wish, that his family knew everything about this, and that he had previously signed the forms at our practice as well as during a prior hospitalization. We went on a hunt through the electronic medical record to find this information, and after multiple clicks, we were able to get to the place where it was supposed to be filed. Nothing was there, but we ultimately did find a scanned image under the media section.

Surely there can be a way that we can build this critical, lifesaving information into the electronic medical record in a way such that it is universally available to everyone trying to take care of a patient. There has got to be a better way to collect and collate all of the critical information we need to take care of our patients, put it in one place, and make it available no matter the context. If I’m in a car wreck in a city far from home, shouldn’t all my health information be right at the fingertips of those who need it to save me no matter which electronic health record they have?

Perhaps someday we’ll all have little chips embedded in our necks, and someone will just pass a scanner over that spot, and everything about our medical conditions will pop up on the screen. Obtunded in the emergency room? Someone could quickly locate the information they need to take care of you, including your name, emergency contact information, medication list, medical problems, allergies, and whether you were, in fact, supposed to be DNR, or wanted everything done.

No barcodes — yet

Now, I’m not proposing that we put barcodes on our patients or embed chips in their necks just yet, but perhaps there’s a better way to collect all of this information so that it isn’t in multiple hidden silos that need to be re-created over and over again, so that the information is always there, always available, when others might need it.

We’ve all found crusty old medication lists, that ID card that a patient received 20 years ago when they got a stent placed, or family contact information in people’s wallets listing dead relatives, when they present altered or unconscious in the emergency room. But when we need accurate, useful, up-to-date information at our fingertips at a moment’s notice, these might not always be the best.

If health care information is going to be truly portable in the future, visible in every location we arrive for care, then we have to figure out a way to link it to us so that it is always easily available to those who need it to properly take care of us. Making the data we collect patient-centered, owned by the patients, instantly and easily accessible, and theirs to give as they see fit, as the best and only solution.

Fred N. Pelzman is an internal medicine physician who blogs at MedPage Today’s Building the Patient-Centered Medical Home.

Image credit: Shutterstock.com

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