[As written/circulated 2008-09 for the Barnes-Jewish Hospital Ethics Committee members]
Decisions About Aggressive/Intensive Management
I recently asked two residents a couple of weeks into their Medicine ICU rotation – “At any given time, how many of the management plans make no sense to you?” I explained my question did not have to do with the management plans’ internal medical reasoning, but instead the management plans’ link or lack thereof to feasible outcome expectations. They both responded – “50 %”.
Note: An order/action may make sense and indicate improvement when considered from a system/problem perspective, while neither making sense nor indicating improvement when considered from a macro/integrated management perspective. Patients and family members may mistake report of system/problem level progress for macro/integrated level progress (esp. when the latter is poorly communicated).
