Wednesday, October 12, 2011

Family Medicine: Simplifying Complex Decisions for Complex People

While interacting with my first patient of the day, a knock at the door interrupts us.  "Dr., there's a doctor on the line from the hospital."  I excuse myself from the patient engagement and take the phone line off hold, noticing the quick greeting by the hospitalist caring for one of the sickest people in my practice.  We have a discussion about the dire prognosis and challenge of getting the patient to engage in a discussion about end of life decision making.  My patient already would qualify for hospice services, but she blocked the discussion about end of life decisions when I brought it up three or four times previously.

My hospitalist friend and I agree on a plan for my patient to consider.  I've spoken with him on several occasions about challenging patients and clinical decision making.  He's very enthusiastic and intelligent, which I appreciate, as do my patients.  And he cares about them as people.

Since we can't be everywhere at one time, we have to share medical decision making with others, especially including the patient.  How does that happen when they're exhausted and confused in a hospital bed?  How might we humanely move ahead with an end of life discussion when the patient might be delirious and the personal physician has handed off the acute care of the patient to the hospitalist?  How might the complexity of the patient-physician relationship over several years be transmitted into the discussions between patient and hospitalist?

It's difficult, but it's what humans do in our complexity- be human as the major simplifying strategy.  Humanity serves as a simplifying concept in situations such as this.  We care and we share in the context of our mutual humanity.

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