tag:blogger.com,1999:blog-2482732367812174734.post6426430353921975877..comments2024-02-28T08:42:52.675+00:00Comments on The Junior Doctor: Playing GodDr Michael Andersonhttp://www.blogger.com/profile/05340927185641717290noreply@blogger.comBlogger11125tag:blogger.com,1999:blog-2482732367812174734.post-59179226283200122522008-05-27T12:39:00.000+00:002008-05-27T12:39:00.000+00:00I think the descision you made was the right one f...I think the descision you made was the right one for the gentlemans dignity and allowed he and his family to be aware of what was happening however unpleasant the reality is. I am a palliative care nurse working in a hospice and sometimes people are referred to us too late for us to be able to make their last weeks/days good ones, surgeons have just hung on too long before admitting that it's time to stand back and let palliative care do it's job....keeping them as symptom free as possible and enjoying time with their family.I have learnt so much since I changed to this type of work.Gooseyhttps://www.blogger.com/profile/12551343997218901422noreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-13290918410096135282008-05-08T10:44:00.000+00:002008-05-08T10:44:00.000+00:00To anonymous re patient choice - unless the patien...To anonymous re patient choice - unless the patient has watched a very unwell person undergo nigh fatal surgery only to stay in ICU for weeks/months struggling from crisis to crisis can they truly experience informed choice.<BR/><BR/>On the same note - when cancer patients are offered hideous chemotherapy side-effects with the chance of improvement in survival<BR/>-- non-doctors - need only 1-2% chance of success<BR/>-- doctors - need >10%<BR/>-- chemotherapy nurses - need >20%Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-74433457044151098812008-04-24T14:10:00.000+00:002008-04-24T14:10:00.000+00:00i don't want to sound like a pointless critic but...i don't want to sound like a pointless critic but surely you could have explained the situation to the patient and let him decide for himself. it's fair doos that it's tough to give reliable numbers on risk and that it's hard to understand risk but if the patient could give a history then maybe it's worth letting him decide if he wanted to go on full stream ahead or take the quiet way out...Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-16827542966754060292008-04-16T21:19:00.000+00:002008-04-16T21:19:00.000+00:00Working in ICU, I used to see the flip side to thi...Working in ICU, I used to see the flip side to this all the time - people being barely kept alive and flogged on like that for days or weeks on end, until someone had the guts to say enough is enough. If only it had been said earlier, even before admission to ICU, lots of painful memories for families and friends would have been saved. <BR/><BR/>You and I know that your patient's situation was hopeless. Had you operated and by some miracle he hadn't died on the table, he'd havee ended up in ICU, where the family would have got their hopes up only to have them dashed in a couple of weeks, after a traumatic experience for all concerned. This way he gets to go relatively peacefully and say goodbye to everybody. I know which I'd choose!northern nursehttps://www.blogger.com/profile/15446807823303234470noreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-1176880215809831182008-04-13T12:45:00.000+00:002008-04-13T12:45:00.000+00:00I'm reminded of the joke. A good man dies and goes...I'm reminded of the joke. A good man dies and goes up to heaven and meets St Peter at the pearly gates. "Come in" St Peter says "You have been a good man" and he goes in to heaven. "I will come and see you later" says St Peter and the man goes in and sits on his own cloud and plays on his harp.<BR/><BR/>St Peter returns later and asks "How are you settling in?" "Fine" says the good man. "I do have one question, however", says the man "there is an old bloke who is wandering around, with a stethoscope around his neck - who is he?"<BR/><BR/>St Peter replies "Oh, that's God; he like playing at being a doctor".<BR/><BR/>Good, thoughtful and caring blog. These are the kind of issues that, from time to time, we face in General Practice. For what it is worth, I think the anaesthetic decision is the caring decision.Jobbing Doctorhttps://www.blogger.com/profile/15556376882759955757noreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-79814972672385976362008-04-13T00:15:00.000+00:002008-04-13T00:15:00.000+00:00Welcome back!I think you did the right thing. I al...Welcome back!<BR/><BR/>I think you did the right thing. I also agree that a bit of communication between teams would have helped the patient and the family.<BR/><BR/>I can think of more than one occasion where a surgeon has been drumming his heels waiting for the anaesthetist to see the patient then being horrified when the case was cancelled. If a patient isn't well enough then you just don't go ahead. Patient welfare comes first. Not only that the cynic in me thinks that if anything went wrong and the family (I'm not talking about your example now) wanted to sue the surgeon would probably say, "Well now, had the anaesthetist told me the patient was too sick of COURSE I wouldn't have pressured them to do the case." Or maybe that's just my experience of a couple of surgeons!<BR/><BR/>Sometimes we can't make it all better. Sometimes we have to let people go. You did the right thing.SSShttps://www.blogger.com/profile/16208995711559110532noreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-79731315121185026032008-04-11T20:39:00.000+00:002008-04-11T20:39:00.000+00:00Thanks for the welcome back, it's amazing how much...Thanks for the welcome back, it's amazing how much more difficult life is without access to the internet.<BR/><BR/>TLM - when I was speaking to the relatives, I tried to make them see what the likely outcomes were with and without the operation, I'm not sure how much of what I was saying they took on board though, there were (understandably) lots of tears<BR/><BR/>Anon1 - I think you're right and it woul have been better had the consultant surgeon and anaesthetist involved spoken about this before telling the family. I suppose these things are made more difficult by there being different surgical and anaesthetic consultants on call on different days of the week. Patient continuity will ultimately suffer.<BR/><BR/>Jo - Thanks for you comment, over on the surgeons blog, a consultant american surgeon <A HREF="http://surgeonsblog.blogspot.com/2006/12/god-of-operating-room.html" REL="nofollow">looks back on the times when he's had to make similar decisions.</A><BR/><BR/>Tazocin - As a former medical SHO myself, I've been in those situations too many times and can well empathise with what you say.<BR/><BR/>1 - Consultant anaesthetists are really supportive of their juniors, much more so than in any other acute specialty IMO<BR/><BR/>2 - More and more I realise that other specialties have little idea what anaesthesia involves. I think that the "relaxed" demeanor of a lot of anaesthetist gives the impression that there's not much to it and the low complication rates of anaesthetics gives the impression that not much can go wrong. Both are fallacies and I'll blog more about this another time<BR/><BR/>3 - Yeah, point taken. There were no surgical emergencies at that point in the afternoon, so me and the surgical team went to have a coffee in the mess where we found the Med Reg having lunch. I wouldn't say this was a common situation though!Dr Michael Andersonhttps://www.blogger.com/profile/05340927185641717290noreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-58964527645807948082008-04-11T18:46:00.000+00:002008-04-11T18:46:00.000+00:00Glad to have you back!Glad to have you back!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-66482977391411955932008-04-10T11:57:00.000+00:002008-04-10T11:57:00.000+00:00Welcome back!Wow - a dilemma that I would never li...Welcome back!<BR/><BR/>Wow - a dilemma that I would never like to have to face. It doesn't sound like there was much of a choice; at the most a successful operation could give him a week more. (and if the predicted chest infection did the same thing to him that it did to my grandfather, then it isn't exactly a week of life)<BR/><BR/>Thank you for your post - incredibly thought provoking.Johttps://www.blogger.com/profile/17965300148218903639noreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-14919649847674296542008-04-10T11:47:00.000+00:002008-04-10T11:47:00.000+00:00Yeay! Welcome back. We've missed you.It sounds l...Yeay! Welcome back. We've missed you.<BR/><BR/>It sounds like a difficult situation. Perhaps it might have been helped if Mr Johnstone's first message wasn't 'You need surgery and then you'll be fine,' but rather 'We'd like to operate if we can, but we need to investigate the ramifications.' That might have set his (and his family's) expectations a little more in line with reality. <BR/><BR/>Having said that though, I think what you did makes perfect sense. If it can't be done safely, it can't be done. It's unfortunate that the man was looking at dying a lot faster than he'd anticipated, but he must have known his body was shutting down in various ways. Sometimes it's just done as much as it can handle, don't you think?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-2482732367812174734.post-70002221157421285202008-04-10T08:22:00.000+00:002008-04-10T08:22:00.000+00:00A very insightful and though provoking post. I thi...A very insightful and though provoking post. <BR/><BR/>I think the what happened was the right thing. Obviously such a decision should never be taken lightly, and by the sounds of it, a lot of thought was put into it. It is such a difficult situation, especially as the patient and relatives are unlikely to understand all the details of the anaesthetic etc etc.The Little Medichttps://www.blogger.com/profile/05743228690074334742noreply@blogger.com