Comments on Pallimed: Case Conferences: What Is That Guy Thinking? When the Attending Is t...

Please note an edit was made:(Edit: (6/16) Added m...

2008-06-17T10:33:00.000-05:00

Please note an edit was made:

(Edit: (6/16) Added missing fragment "...consultant believed that the patient was dying and spoke with...)

I think a lot of what the palliative care team is ...

2008-06-17T10:31:00.000-05:00

I think a lot of what the palliative care team is about the style of communication, and this case does not necessarily expound on the how's or the particular words that were used.

I think this approach of acknowledging different viewpoints on a patient's prognosis is helpful to a degree, but when different doctors have greatly different views on prognosis it can be very important to have a frank discussion of why the two estimates of survival are so different.

I think the teaching point Ms. Chaitin is trying to clarify is that direct confrontation may not be the best approach in all situations. I agree some more information about what was said would be helpful.

The statement:

"The approach the Palliative Care and Ethics Team chose was
to focus their discussion on acknowledging the attending’s
viewpoint and clearly communicating their understanding of
his dedication to his patient, rather than choosing to register
their disagreement with his viewpoint."

may encompass a whole lot of conversations over time that this format did not allow for more detail.

I will try to contact the original author for more details.

I'm interested in this case as this is a common sc...

2008-06-16T21:58:00.000-05:00

I'm interested in this case as this is a common scenario is my practice as a hospitalist. I'm not sure, though, that I fully understand what the pall care/ethics team did. The consultants communicated that they believed the primary attending's motives were beneficient. However, they "left out" that they thought his/her judgement was incorrect. Surely something more nuanced must have been communicated to change the plan of care. Someone must have communicated the FACT that the pt's prognosis was so poor that a feeding tube wouldn't prolong life. What then was communicated?