Doctors that think they are god...

  1. I am increasingly becoming sickened by a group of docs where I work. They seem to keep their pts alive at ALL costs. I have heard one of them tell the daughter of my pt that the pt didn't have anything he couldn't "cure" and that she was "not terminal." This about an 85 y/o woman with sepsis, COPD, etc, etc, etc....stating she wanted to go home with her daughter to die. Doc makes daughter (POA) feel like she is killing her mom if she brings her home...All Holy Doc can CURE her!!

    This is only one little story (there are more)...I am just curious, since I am newer to nursing, where is the line drawn? What can I do for my pt that is honestly being tortured, by a group of docs that think they are god, before the inevitable?? I am newer to this hospital, but this group has a horrible reputation for keeping people alive at all costs. ALL the RNs talk about it & can't stand them. I have seen it numerous times in my own short period there. Why is nothing done...or, what can be done??

    Also...would you agree that it is more the docs are $$greedy$$ and need to keep their bankroll alive to get the medicare payments than that they are "trained to save lives" and can't give up??????

    Thanks for any input...very tired hope this made sense!

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  2. 40 Comments

  3. by   GingerSue
    "keeping people alive at all costs"

    "85 y/o"

    "before the inevitable"

    - excuse me, who decides what is inevitable?
    - recently my own family member (88 y/o) was in hospital and I shuddered to think that staff were "writing him/her off" - and he/she wanted to go home, he/she came in for treatment - not to be written off -- this person is now recovering from a dreadful infection and is no longer bedridden, but up & walking, in a convalescent facility (instead of written off placement), where he/she gets dressed and up every day, motivated, doing well, and as staff mentioned the other day (a delightful white-haired older RN) - "people walk out of here"

    I say - assess and plan for each patient as an INDIVIDUAL - not according to preconceived notions about what an 85 y/o individual's future holds

    (incidentally, in home health nursing I have worked with people over 100 years of age who are managing quite well at home, with some services who come into the home - let them live their lives at home if that is their wish)
    Last edit by GingerSue on Feb 6, '07
  4. by   DebRN06
    First off, I wasn't talking about your family member. You read into things that weren't there and made things up in your own head. This pt will never walk out of anywhere. I didn't think I would have to get overly involved in my post and assumed (yes, I should know better than assume) that any rational person would get my point without me having to put every detail of the woman's health history.

    Did you read the part about her wanting to go home with her daughter to die???????

    Incidentally, I have also worked with people over 100 y/o who are managing quite well at home, but what does that have to do with the the price of corn???
  5. by   GingerSue
    assess each person according to their individual condition and don't base care decisions according to preconceived notions
  6. by   traumaRUs
    Hi there Deb and welcome. There is an ethics committee at each hospital which might be an avenue for you and your fellow nurses. There are also chaplains that might help you sort through things. And...finally, if the daughter (POA) is saying that she wants to take Mom home, then you can also contact a social worker for assistance.

    Gingersue - I am glad that your family member is recovering. However, in the original post, it was made clear that this pt wanted to go home. There is nothing wrong with prolonging life at all costs if that is what the PATIENT wants. However, in this case, that is what the DOCTOR wanted.




    "Also...would you agree that it is more the docs are $$greedy$$ and need to keep their bankroll alive to get the medicare payments than that they are "trained to save lives" and can't give up??????"

    Deb - I do disagree with this statement. Nowadays, doctors themselves don't get extra money for keeping anyone in the hospital. We are repeatedly told to get these patients moving out of the hospital. With the billing being dependent on the DRG, it is not fiscally feasible to keep folks in the hospital longer than absolutely necessary.

    Have a good day guys....traumarus
  7. by   DebRN06
    Gingersue...
    Thanks for the advice...next time can it actually have something to do with what I posted about in the first place?? When I said "thanks for any input" in the OP I should have instead said...Thanks for any relevant input.
  8. by   sirI
    Quote from traumaRUs
    Hi there Deb and welcome. There is an ethics committee at each hospital which might be an avenue for you and your fellow nurses. There are also chaplains that might help you sort through things. And...finally, if the daughter (POA) is saying that she wants to take Mom home, then you can also contact a social worker for assistance.

    Gingersue - I am glad that your family member is recovering. However, in the original post, it was made clear that this pt wanted to go home. There is nothing wrong with prolonging life at all costs if that is what the PATIENT wants. However, in this case, that is what the DOCTOR wanted.




    "Also...would you agree that it is more the docs are $$greedy$$ and need to keep their bankroll alive to get the medicare payments than that they are "trained to save lives" and can't give up??????"

    Deb - I do disagree with this statement. Nowadays, doctors themselves don't get extra money for keeping anyone in the hospital. We are repeatedly told to get these patients moving out of the hospital. With the billing being dependent on the DRG, it is not fiscally feasible to keep folks in the hospital longer than absolutely necessary.

    Have a good day guys....traumarus
    :yeahthat:
  9. by   LuvMyGamecocks
    Quote from DebRN06
    Gingersue...
    Thanks for the advice...next time can it actually have something to do with what I posted about in the first place?? When I said "thanks for any input" in the OP I should have instead said...Thanks for any relevant input.
    Jeez. :trout: Kinda harsh, don't you think?
  10. by   DebRN06
    Quote from LuvMyGamecocks
    Jeez. :trout: Kinda harsh, don't you think?
    Perhaps...but I think GingerSue's conjecture that I "write people off," don't "assess and plan for each patient as an INDIVIDUAL" and that I have "preconceived notions about what an 85 y/o individual's future holds" was uncalled for and inappropriate.
  11. by   NRSKarenRN
    " an 85 y/o woman with sepsis, COPD, etc, etc, etc....stating she wanted to go home with her daughter to die. Doc makes daughter (POA) feel like she is killing her mom if she brings her home..."

    "ALL the RNs talk about it & can't stand them."

    These are very moving statments that there is a disconnect between physicians providing care and patients/nurses perception of what care + treatment should be provided, informed decision making along with physicians HEARING patients wishes.


    Trauma has given you excellent advice. Since you are a new RN, ethics committee/ ethical decision making should have been addressed as part of orientation regarding resources within your facility. Please discuss this with your nurse manager.

    As a new RN, had similar feelings regarding an oncologist who didn't stop treament when asked to by patient/parents. The night a patient coded for seventh time and father stood spread eagle in the hospital doorway to prevent code team from entering was turning point for me. The nurses had talked about doc amongst ourselves but never formally asked for meeting/inservice on how to consult ethics team or report our concerns re physicians not listening and following patients desires. That changed only after this unfortunate incident which happened ~25 yrs ago.
    Learning to be assertive for our patients rights and needs comes with time and experience.

    You definately need to discuss with manager this situation and how you can be better prepared in the future to ensure your patients desires are followed. Suggest a talk session or inservice as other nurses on your team have similar concerns and were unable to guide you in making right contacts.

    Good luck in handeling this sensative issue.

  12. by   burn out
    I think that perhaps you are in the wrong area of nursing because unless the patient is a DNR that is what we do in hospitals ...keep people alive at all costs. Until we have legislation that makes euthenasia mandatory at a certain age we will continue to keep old people alive at all costs too.

    Are you burned at the arrogance of the doctors or the fact that patients will be kept alive? If you really have a hard time dealing with this kind of care maybe you would be suited more to hospice type care.

    Have you been a nurse long? Because if you haven't then maybe you haven't been around long enough to see some of the miracles that do occur, then it is worth hanging around for. I don't mean to sound harsh but if you really feel like "they are just going to die" then you are not doing any good for the patient, family or yourself. I wouldn't want you to care for me because guess what I am going to die one day and so are you. I want one of those doctors that will treat me no matter what the cost..life doesn't or shouldn't have a price tag even though I feel like we are moving in that direction and we will as long as we have nurses that feel like you.
  13. by   Mags4711
    Geez oh petes! I NEVER thought the OP was saying she wants to write people off.

    Come on folks, admit it, we've ALL seen docs who push and push and push to keep patients alive that we know in our heart of hearts: a) will never recover, and/or b) WANT to go to the great beyond in the arms of their loved ones.

    And if you've never, ever taken a person off a vent whose heart was still beating, or if you've never given someone a nice dose of morphine while their family was either holding their hand or laying along side them, then I am unsure quite what to say to you.
    That is what we do, we advocate for what we believe our patients and their families want. Sometimes it may not be what we personally believe. Sometimes we have to step in when we see something amiss and help guide the patient and/or their family to understand exactly what is going on, rather than what the doctor is telling them. I do agree with the OP that many docs "flog" their patients. I do not know why. I agree with whoever it was that said they do not think it is greed. I don't think it is either. I think part of it is not wanting the mortality stat on them. Hate to say it, but I do. I worked Trauma for a number of years and I cannot tell you how many times I had a team from the OR rushing a patient back to the unit with someone riding on the bed doing compressions and someone else pushing products into them, then depositing them into their room in the ICU, and calling it. Why? Because the mortality does not count against the OR stats, plain and simple, it counts as an ICU death.

    I want to say so much more, but I worked last night and I've been up for well over 24hrs. I can't quite think straight. I may read what I've written later and edit the heck out of it. But I needed to respond to this in some way.
  14. by   Creamsoda
    Burn out, dont you think your being a bit harsh? I agree with the OP totally. There are some docs that are realistic about outcomes, and others that arent and have their own agenda. As the patients nurse its ok to talk to the patient and daughter and reinforce that if this excessive treatment is NOT what the patient wants, then they can say no, and the daughter can say no if POA. It can be very frustrating as nurses caring for these people knowing they are suffering with very little chance of getting through it. Yes the rare miracle happens, but not always. Has a family conference been aranged for this particular patient?

    Cher

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