First do no harm

It’s been a few years now since I put the Dr. prefix before my name.

I am a medical registrar. Some part of the world call it the internal medicine. I would be, one day perhaps be referred as a physician, as opposed to a surgeon, anaesthetists, an obstetrician or a pediatrician. I do often hope that I would be a good one.

As a doctor, I would deal with deaths and sufferings more often than most people in the world. It’s a privilege, say some. It’s a burden, say others. In caring for my patients, especially in the elderly, I make it a habit to discuss about advanced care plan. To the uninitiated, it’s basically a plan put in place just in case things go wrong, real wrong i.e. a cardiopulmonary arrest where the heart or the breathing or both of them, stop, for whatever the reason. To crack the rib or not with CPR. To intubate or not. Or to shock or not.

I often get some surprising responses from the family or the patient. Often, in the event of a cardiopulmonary arrests, we rarely bring them back. Even if they are successfully resuscitated, the elderly patients wouldn’t leave the hospital alive. Most family and patients accept the likely futility of such drastic measures once it is explained to them the details of what it really entails and they would elect not to proceed with resuscitation.

Most, I say. There’s always a group of patients or family who would push for such measures regardless of the doctors’ recommendations. The cynical me, often see them as belonging to patients who don’t look after their health or family who had not been treating the said patient well. Having the discussions in the early days of a hospital admission is essential to ensure everyone is on board with the decisions made and to guide the aim of patient’s treatment.

As a medical registrar, I often make a decision on the resuscitation of my patient, literally influencing life or death. Sometimes, the patient or family would like patient to be resuscitated. Then, I would gently remind them, it would not be up to the patient or the family. The decision on resuscitation would be left up to the treating doctors at the time of arrest. The overriding principle is always going to be – first do no harm. The resuscitation order is to minimise the risk of harming the patient and to minimise the risk of doctors doing anything untoward or against the patient’s wishes.

Some people might argue that would be unfair to the patient and doctors are playing God – deciding life and death. However, what people do not understand is that, doctors today are very cautious in their decision making, always taking the low risk approach. There’s no one patient that would be worth a doctor’s decades long career. If the decision was made by the doctor not to resuscitate, it would be best to keep in mind, that’s probably the most appropriate decision taking all factors into account.

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There have been to many sick patients and deaths in the unit over the last 3 weeks. That’s a little bit depressing.

Arrivederci