Thursday, January 13, 2005

Doctoring and Medical “Errors”

I was asked to explain the word “Doctoring”. What does it really mean? What is it that we do?

I have dedicated a lot of my fatigued, emotionally drained brain power to this and I’ve come up short. There really is no way, without including exceptions, to define "doctoring". To the best of my knowledge, it would be: To have the patient’s best interests in mind at all times and to act on behalf of these interests.

A number of dilemmas arise and they are best explained in this example. What if your patient is eighty year old, is extremely demented, is unable to get out of bed, unable to communicate and is being fed by a tube. What if he’s become only a shred of the powerful, energetic man you once knew and that, as his physician, you know that he would never have wanted to live like this. BUT, he never wrote that down officially, anywhere.

Now, what if this same patient has a very weak heart and according to the "standard of care" you really should insert an internal defibrillator. On the one hand, you’re a good doctor and you want to protect your patient from dying and, of course, you from getting sued. On the other hand, death would be a blessing and an end to his suffering and sometimes that’s "doctoring".

Now I know, you’ll say something like talk to the family, explain this and that, etc. You will find it upsetting when I say that lay people do not understand medicine and don't have the ability to comprehend prognosis. Family members are often unrealistic in their hope for recovery and often that forces us to do things that we normally wouldn’t do just because an “indication” exists.
If the family wants everything done then we do it.

Did we act as doctors then? Is this a medical “error”? We have failed the patient but satisfied the guidline. No official error committed. How about unofficially?

p.s. If one of you can come up with a better explanation of “doctoring”, please comment.
p.s.1: Please make a health proxy now and make him/her aware of all your wishes for end of life issues: DNR in any case, nutrition and hydration. All this becomes unbelievably important regardless of your current age.
p.s. 2: I didn’t mention lawyers, although, they are ultimately the problem behind all of this. J.D. type away!