Communication Rants and Raves

Us vs them

Well, it’s happened.  Not that it hasn’t happened before to varying degrees, but it’s really happened this time.  Today, I inexplicably became “one of them”, a stranger somehow on the other side of a what-are-we-going-to-do-with-mom fence.  After spending hours trying to do what seemed the best thing for a patient (and in keeping with her advanced directive which she filled out 3 years ago at the age of 88), I caved and bent to the will of the family.  Nothing too extreme like a central line or intubation, but against my better judgement and medical training, and possibly exposing her to unnecessary risk in the hospital.

I’m disgusted.  Not with my chosen profession, but with the horrific state of our so-called “health” system.  In no other country in the world would I have done what I did today, for several reasons – it wouldn’t have been an option, the family wouldn’t have demanded it in a threatening tone, and my attendings wouldn’t have been scared of being sued.

We must expect better from our system.  No, we must DEMAND better – more time and pay for conversations regarding end of life, quality of life, and rationing of health care (that’s right, I said it.  And I’ll say it again – we don’t have enough resources as a society for everyone to have everything, and we have to draw the line somewhere).  Tort reform.  Societal trust in physicians and their point of view.  Realistic expectations of what medicine can and can not (or should not) do.

I am just as guilty as many others – complaining about a broken system I feel powerless to change.  Trudging through the trenches with my head down trying desperately to afford change in just one person’s life, hoping to provide just one 20 minute conversation that will help a patient navigate the end of their life.  Knowing that of the many things we can do TO people, very little of it will make them feel better, live longer, or enjoy the time they have left any more.  On the contrary.

One of the attendings I was working with tonight said it best.  “What ever happened to the time when the doctor just made a decision in the best interest of the patient, and that was that?”  Certainly, none of us would advocate a completely paternalistic system.  But we’ve swung so far the other way that we are literally crippled with shared decision making and the (unrealistic) expectations and demands of non-medical patients and families.

I challenge myself to re-invest in political endeavors and lift my head every once in a while to acknowledge the changes that are being made.  I reject the notion that I’m powerless and I refuse to allow the system to make me feel like a vending machine full of pills and procedures. 

Opportunity for growth – reason #328 why I love my job.