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    Wednesday, February 21, 2007

    The Status We Want: One of the most frustrating phrases to find written in a patient's chart by a consultant is "This patient needs a code status." Not because it's annoying to have someone point out that it needs to be discussed, but because that phrase only pops up when the consultant disagrees with the choice the patient has made. The patient's decision to have aggressive medical care can be documented in every progress note in the chart, but still that phrase "needs a code status" will show up in someone's note. What they really mean is "this patient should be do not resuscitate," but they don't have the courage to write it.

    The other day I had this phrase flung at me verbally by a critical care specialist who had to consult on a patient of mine who took a sudden turn for the worst. He's in bad health, to be sure, but he isn't terminal. And he wants aggressive medical therapy.

    Intensivist: "This guy needs a code status."

    Me: "He has a code status. He's a full code."

    Intensivist: "Who decided that, his wife?"

    Me: "He did."

    Intensivist: "I'll take care of that."

    Me: "That's his decision to make and we have to respect it. Sorry if it increases your work."

    I hope that softened his approach, because it certainly sounded as if he was going to be very confrontational with the patient who was in extremis. In any event, my patient didn't change his mind. And who can blame him? He was told five years ago he would be dead in six months from his aortic aneurysm that no one dared repair. But here he is. He was told one year ago that his foot had to be amputated, but he sought a second opinion and found a vascular surgeon who managed to save his foot as well as repair his aneurysm a few months later. He doesn't exactly have the highest confidence in the prognostication abilities of modern medicine.

    It's the hidden agenda behind that phrase "needs a code status," that's so frustrating - or more accurately dispiriting. It too often means "I don't want to put in the effort on this patient," rather than "we have nothing to offer this patient." That's why physician-driven euthanasia is such a dangerous trend. You can't trust us to act in your best interest instead of ours.

    posted by Sydney on 2/21/2007 07:41:00 AM 1 comments


    I too see it frequently.

    As a nursing home doc, vegetative patients often return from the hospital with notes in the Aseessment/Plan section after renal / id / cardiovasc / etc. like "Need to address code status with family". This really frickin' pisses me off.

    As if we are just skirting the issue and keeping families in the dark about prognosis, giving them false hope that terry schiavo is going to wake up with "intensive therapy" after 10 yrs in PVS. We discuss code status on a frequent basis with families, and we're damn good at explaining it (not PUSHING families to make grandma DNR but explaining the often very limited potential for resuscitation and great potential for suffering if coded).

    Somehow an ER doc or intensivist sees schiavo is a full code and decides the ignorant and lazy nursing home docs didn't do their job. If that's the case, howcome these patients never return from the hospital with a change in their code status???

    By Blogger Happyman, at 9:09 AM  

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