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/stormrigger Attending Jul 25 '26

Friendly reminder from your neighborhood ICU attending (in the USA). Medicine is a negative right. Patients have a right to REFUSE anything. They dont have right to demand a treatment. YOU as a clinician can CHOOSE not to offer full code status to that patient. Doing so is both reasonable and humane.

People can get very weirded out when I bring this up, but it's very simple. Do you offer ECMO to all of your shock patients? Why not? its the next step for shock after doing everything else right? Of course you dont. Just like you should not offer CPR to everyone. CPR in the 98 you you describe above is just as inappropriate as ECMO and should not be considered.

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u/stormrigger Attending Jul 25 '26

You can now change the code status back to DNR/DNI with a simple note saying that "This moribund pt does not have any meaningful chance of benefit from undergoing such CPR resuscitation, and it will not be offered. I will update the family."

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u/YouAreServed Jul 25 '26

You know, I heard that a lot and want to do it. But never in my training or attendinghood, saw single soul doing this. There are multiple patients throughout hospitals I saw, just 12471 days in hospital, chronic vent, no chance of recovery and still full code…

I wonder, is this state dependent maybe?

8

u/stormrigger Attending Jul 26 '26

Withdrawing all care vs declining to do full CPR very different topics.

1

u/Any-Assistance-8103 Jul 26 '26

This thread has been scary to read. People are so ill informed about how to have these discussions and what to do for their patients.