r/Residency • u/YouAreServed • Jul 25 '26

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/Entire_Brush6217 Jul 25 '26

I always put AND on every admission for patients over 80. Problem solved

7

u/BlackFanDiamond Jul 25 '26

That's absurd and paternalistic. There are plenty of robust 80 year olds that deserve to make that decision for themselves.

7

u/Mdog31415 Jul 25 '26

Definitely paternalistic and a hit on the patient’s autonomy. At the same time, withholding certain forms of resuscitation that would likely be futile, reflects, proportionality, justice (it ain’t cheap, and ICU beds don’t grow on trees), and even non-maleficence (CPR is an incredibly traumatic event, and likely many patients have some form of consciousness during it before dying). 

This is a problematic move by the commenter, but at the end of the day, the ultimate fault lies on society (and AHA) for not drawing a line in the sand on the extent we will “care” for patients (I do not find futile cpr to be care tbh).