--- [log in to unmask] wrote:
> > from: Fred Cartwright <[log in to unmask]>
> > subject: Re: Guidelines
> Not quite true Fred. Much of a surgeon's training
> concentrates on when to operate, rather than how to
> operate. You know the saying, "choose well, cut
> well, get well". The surgical exit exams contain
> very little in the way of "operating" content, but a
> considerable amount of time is devoted to the
> "choosing" areas of their craft, together with
> postoperative care.
Well I don't know how some of them get through then,
because the standard of preop selection is appalling
in this hospital!
>
> > Most of
> > the drive for introduction of DNR orders and the
> > general awareness of when not to resuscitate has
> come
> > from the resus department!
>
> Only to be politically correct, I get the impression
> Fred!
Knowing the individuals concerned I doubt that they
would do ANYTHING for political correctness. When you
go to every resus not just the odd few that most docs
do you see some of the poor decisions to resus that
are often made and want to do something to stop it!
> Even then the emphasis is wrong, it suggests
> the "default" mode is to resuscitate and an active
> decision has to be made to not resuscitate.
That is the default mode and there has been a lot of
opposition amongst some of the medical staff that any
of their patients should not be for resus! They want
them all done however hopeless.
> In many situations, such as terminal cancer, it's
> completely wrong to even consider resuscitation,
What is terminal cancer? Anyone with cancer that is
going to kill them however well they are? Let me give
you an example. Someone with disseminated Ca, but
otherwise well having first dose of chemo has an
anaphylactic reaction. Do you stand back and let them
die or treat them?
> and
> it's usually cruel to discuss this with the patient,
> let alone force them to sign some sort of document
> to that effect.
Why? Is pretending it is not going to happen any
better?
> Oncologists and palliative care
> doctors don't need to write DNR orders. It's taken
> as read that their patients are going to die some
> day.
>
We are all going to die someday!!! I think you will
find palliative care docs talk to their patients about
dying quite a lot. It is just the rest of the medical
profession that are squeamish about it.
Cheers Fred.
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