Paul Levy: End-of-life Conversations, as Seen By the Intensivist

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The following is reprinted with permission from the blog, "Not Running a Hospital," authored by Paul Levy, former CEO of Beth Israel Deaconess Medical Center in Boston.

My recent post on end-of-life care issues, "What if they had had to pay?," generated a lot of comments in the blogosphere and beyond. One intensive care doctor sent me a particularly poignant note.  It gives a good sense of what it is like on this person's side of the bed.  The note re-emphasizes the need for better end-of-life planning, for the sake of patients, families and providers.

Here's my day so far. This is my first day of a 7-day stretch in a tertiary ICU. The average census in this ICU is 10, but today we have had to surge to 15.

Let me stop right there. This is doctor (and nurse) shorthand for, "I expect to be very busy, very tired, and very stressed out. I am going to have to make some highly critical clinical judgments, sometimes with very little time to react. I don't know anything about these patients beyond what is in the charts and what our care team sees and hears for themselves."

Two patients today coded in our hospital. One family wants "everything" done, and seemed shocked to learn that I don't think it is right to provide "everything." The other family wished someone from the healthcare team had bothered to ask them what their 89 year old dad would really like to accomplish from his hospital stay before he tried to die. We decided to let him finish dying.


And I had 3 other similar discussions with patients or their families about goals that can actually be achieved. All of them were already in the ICU, having had no real clear previous discussions. One of those patients was admitted last night, but the other 2 had been in our ICU for days....

Related Articles Featuring Paul Levy:

Paul Levy: Good Diagnosis, Zeke. Why No Cure?
Paul Levy: Hospital Leadership Must Prioritize Patient Safety

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