I’m back in the office for at least today. Comments are caught up on the blog.
Catching up with email, an item from Monday, October 22nd caught my eye. It’s from the NY Times Health Blog. Columnist Tara Parker-Pope lays out a scenario that will be familiar to readers of this blog in “When Doctors Steal Hope“:
A 79-year-old woman I know suffered a stroke recently, and a doctor in the emergency room told her family there was nothing he could do. The family was devastated. The woman’s 24-year-old granddaughter ran to the parking lot and vomited, then spent the rest of the night at home with the family, sobbing with grief.
But the next day family members returned to the hospital room to see the woman sitting up, drinking a milkshake. The nurses even had her out of bed and walking to regain her strength. She clearly has a long recovery ahead of her, but three days after the doctor’s first grim prognosis she left the hospital for a rehabilitation facility. The family was whipsawed by the emotional events. Why, they wondered, hadn’t the doctor told them a recovery was even remotely possible?
The rest of the blog entry contains a discussion of the possible motivations of physicians in this type of scenario, which is treated as all-too-common. As part of her exploration, Parker-Pope solicits the input and expertise of Dr. Jerome Groopman, the author of several books, including “How Doctors Think.” Groopman was the author of the New Yorker article discussed on this blog recently. Here’s what Groopman had to say to Parker-Pope:
Dr. Groopman says he is troubled by stories like the one involving my friend, but he’s not entirely surprised, either. In the case of stroke, for instance, treatments are inexact and recovery largely depends on the body’s own ability to heal itself. “When the physician feels that he or she really can’t do anything active, they tend to take the most negative scenario as the likely one,’’ said Dr. Groopman.
And well-meaning doctors often see less harm in having been wrong when a person recovers than wrongly predicting a recovery that doesn’t happen, he explained. “In some ways it’s easier to give people the worst news, and then if something good comes about everyone is overjoyed,’’ he said.
Both Parker-Pope and Groopman are missing – or avoiding – another aspect of this behavior. When these individuals with stroke, brain injury, etc. are described as “hopeless” the next step is often a discussion of the removal of the ventilator or feeding tube that is being used in those first days and weeks post injury or illness. By avoiding this aspect, Groopman and Parker-Pope are avoiding the issue of the life-and-death consequences of these “rush to judgments,” as Diane Coleman recently called them.
And by avoiding that issue, Groopman is missing another possible motivation. At least some doctors might be motivated to nudge families toward removal of life-sustaining treatment, figuring the death of the individual is a better outcome than the stress the family would experience with the long rehabilitation and level of disability that their loved one may very well face. Referring once again to Diane Coleman’s blog entry on the topic, at least a couple of bioethicists have suggested that as a legitimate course of action for doctors.
The New Yorker article and this recent blog entry by Parker-Pope are welcome entries into new territory regarding the uncertainties facing people with neurological injuries. Let’s see if someone out there in the mainstream press can carry this discussion the rest of the way home. –Stephen Drake