During my cardio placement, I have seen a few sets of patient's notes with a blue tab attached to one of the pages.
The blue tab marks the page in a patient's notes where there are instructions about DNR (do not resuscitate) if there are any. Maybe I was asleep when it was discussed, but I don't recall learning about this crucial bit of info at school.... My supervisor told me about it after I had been on prac.s for >5 weeks.
This, and the very poor health of some of the pt.s we see got me thinking about the balance between keeping people alive and minimizing suffering. There is no doubt that, for some patients, there comes a time when the two goals not aligned. One patient we were treating was discussed by one of the health care team as "...just needs to die". Not at all out of callousness; quite the opposite: it seemed plain to these experienced practitioners that there was no point in prolonging the patient's life, as he didn't seem likely to live and was suffering.
Of course, that doesn't make any difference to us: we would never decide not to treat a patient. However, I can't help wondering about the whole thing: when i finish giving some patients chest physio, they are exhausted and look worse that when I started even though they are breathing easier and are perfectly capable of declining treatment. I guess they do feel better and / or they blindly trust that what we do is good for them.
My reflection on the matter is this: how do we take patient suffering / will-to-die into account? All of our treatments are supposed to be evidence based practises, but how do studies take into account the balance between prolonging life and prolonging pain? Has anyone seen any studies that try to incorporate these factors?
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hi ed, i've not seen any studies that incorporating prolonging pain and life but i do know that hospitals nowadays have teams that help to maintain the quality of life of the patient when the prognosis is very poor (eg if the person has multiple metastases in multiple places--such as the palliative team and the pain services?
I guess as ethical physios-to-be we would want to get in there and do chest physio or something but with patients with very poor prognosis, i guess the priorities are different? Take the people with the post-polio syndrome as a parallel to people who have such end-stage disease? these patients really can't expect to improve unless there happened to be some miracle cure? so then all we can do is to maintain or improve their quality of life and rather than tire them out with one session of physio, perhaps maybe keep them happy by doing what they feel up to for now and then going back for more?
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