Case study: End of Life Care

Keywords: end of life attention family, family help palliative care

In describing a predicament in which my integrity was challenged I'd first prefer to give some qualifications. This involved an individual I cared for and I am going to anonymize the problem for privateness concerns - he'll be referred to as Patient A. The patient was a middle older male who had been diagnosed with malignancy. He initially dropped therapy anticipated to personal values that he and his better half had about substitute medicine. A yr later, with development of his tumors, he decided to chemotherapy but at that time his cancer tumor was very advanced. He at first came under my health care by the end level of his cancers, and when I accepted him I did not expect he would survive to discharge. His wife was of the thoughts and opinions that he previously declined because he agreed to chemotherapy and expected him to improve now that chemotherapy have been halted. During his entrance he increased and was discharged. At release I proceeded to go over his condition with him and his partner, and mentioned his expected continued decline in detail.

About a month after this I again admitted Patient A. He was in very bad condition and hadn't eaten much for approximately per month. He needed to be accepted to the Intensive Care and attention Unit. He was lethargic, with a waxing and waning mental position. I was concerned that he would not have the ability to swallow properly and may likely aspirate (with attendant difficulties including pneumonia) if fed, so I performed off on nourishing him till his mental status increased, sustaining him in the interim with intravenous diet/fluids. I also halted some medications he previously been on previous to entrance including synthroid, a medication for thyroid dysfunction. I primarily mentioned Patients A's condition with him (when he was more awake) and he decided he didn't want to be resuscitated if his heart and soul quit. When his partner was available I sat down with her and we had a long discussion involving his condition and his prognosis. She was very personable but was convinced that his prognosis was better than I used to be making out. She was also very concerned about Patient A not wanting to eat and not getting his thyroid medications. I explained the explanation for my not wanting him to consume yet and explained that thyroid medication could worsen a complication he previously at that time. Despite our discussion she was still persuaded that his prognosis was very good. I concluded the dialogue by requesting her to think on things and appealing to go over further with her at another time. However, when I did so see her later she accused me of not taking enough care of her hubby. She felt I used to be quitting on him and going out of him to starve. She also thought he would be doing better with his thyroid medication. She wanted that a different physician be put responsible for her partner.

Taking good care of patients by the end level of life can be difficult. It really is especially so when the patients are relatively young. The surviving family also frequently have survivors' guilt, with a propensity to feel they could did more. In cases like this Patient A's partner believed there is far more that might be done that may change the outcome.

I experienced her accusation was a problem to my integrity and was very astonished, especially as I thought we'd come to a knowledge when previous we spoke. She was essentially accusing me of not only insufficient care and attention but of harming my patient. I gave Patient A's major care medical doctor a call to go over how she had been getting together with Patient A and his partner. Then i sat down again with Patient A's partner and we'd another long discussion at the end of which I decided to let Patient A go to eat. I agreed to this knowing that he could aspirate. In view of his expected imminent demise I noticed if he could easily get some comfort from eating, it would be worthwhile. However I did not agree to recommence Patient A's thyroid medication which would at that time have hastened his demise.

I believe I used to be at fault in not properly addressing her concerns in the beginning. She was experiencing individual trees and not the forest. But I used to be also going for a coldly clinical procedure. While I was medically right, a deeper view should have shown me that at that point his comfort and his wife's satisfaction that he had received appropriate care and attention must have been paramount.

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