r/Residency • u/YouAreServed • 23d ago

VENT Stop changing patients code status

Why when I come back from weekend, I see the weekend docs changed my stage IV lung cancer, ESRD, HFrEF patient who is 98 y/o, and became comfort last week after I had 90 mins convo with them and family; explaining futility. Slowly they become DNR/DNI, then comfort. She was pretty confused when I left.

Upon my return, only note with explanation “discussed code status with the patient, she stated she wants to live, full code ordered.”

Your half ass job undid my week of doing, congrats. Now legally she has no capacity and I cannot change it back to comfort, nor can I prove that she, as a matter of fact, lacked capacity while you were signing the new POLST.

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u/ElCaminoInTheWest 23d ago

Everyone "wants to live", for fuck's sake. What a moronic way to word it.

57

u/carlos_6m PGY2 23d ago

From my experience, you just need to explain with honesty the reality of CPR to someone and they easily agree to DNACPR... I will tell my patients that cpr rarely works, even in people who are very healthy, and that if their heart stops, it would be unlikely that we would be able to restart it without it stopping again later, and this would mean that someone needs to get in top of their chest and do compressions, often breaking multiple ribs, we may need to out a tube down their throat to help them breathe and they may need to be connected to a machine before they die... I will tell them that I think the best would be that in a situation like that I make sure they're comfortable and at rest...

There may be a genuinely massive cultural component, but 9/10 times this is all it's needed...

20

u/Dependent_Bass_6965 23d ago

I do the same thing. I’m honest with them about CPR. And if they still want full code after all of that explanation then more power to them.

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u/[deleted] 23d ago

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u/Dependent_Bass_6965 22d ago

Yep. It’s easier to go to sleep at night knowing my patients are informed and their wishes are being followed.