Good Medicine Sometimes Makes Patients Unhappy

"Good Medicine Sometimes Makes Patients Unhappy."  This is the title of a post by Ralph Gordon over at KevinMD.

Gordon describes a medical futility dispute:  “The patient in his mid 80’s came with a massive heart attack. He had a heart attack at home and, unfortunately, wasn’t found until later. He developed muscle breakdown that affected his kidneys. He had to be started on continuous dialysis.  Despite aggressive medical management, his condition had progressively deteriorated. The blood pressure remained low despite the high doses of medications. All major organs started to shut down. The patient was dying. . . .  The refusal to provide futile care lead to a very unhappy family yet it was the right thing to do.  It was the right thing for the patient.”

I think it is worth highlighting two comments made on Gordon’s post.

1.  “On a more serious level of illness, my experience on my hospital’s Ethics Committee has been that the majority of requests for futile care come from newly immigrant or impoverished families, both belonging to populations culturally outside the evolving acceptance generally of the limits of medical care.”  The evidence for this is more than anecdotal, but is now supported by good empirical studies.

2.  “Expect more of this type of EOL scenario as care becomes further fragmented between primaries and specialists . . . .”  I have written on this blog and in articles that there are several reasons why there may be MORE futility disputes in 2015 than in 2010.  While there are significant efforts to improve communication with patients and families, broader changes in delivery systems increasingly impede.