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How do you prepare for disagreement?

Sometimes you might be asked for something that seems entirely pointless. In healthcare almost every speciality has examples of such challenging situations. In intensive care and oncology such issues are most poignant as patients may end up suffering before death:

In a retrospective review, we identified 100 patients of 331 bioethical consultations who had futile or medically inappropriate therapy. The average age of patients was 73.5 ± 32 years (mean ± 2 SD) with 57% being male. Fifty-seven percent of the patients were admitted to the hospital with a degenerative disorder, 21% with an inflammatory disorder, and 16% with a neoplastic disorder. The family was responsible for futile treatment in 62% of cases, the physician in 37% of cases, and a conservator in one case. Unreasonable expectation for improvement was the most common underlying factor. Family dissent was involved in 7 of 62 cases motivated by family, but never when physicians were primarily responsible. Liability issues motivated physicians in 12 of 37 cases where they were responsible but in only 1 of 62 cases when the family was (χ2 5 degrees of freedom = 26.7, p < 0.001).

Seth et al

This scenario may be avoided if it is anticipated as a ‘set play‘. List all the ways you may be adding to the person’s problems and consider how you might avoid contributing to a bad situation.

Picture by Isabelle

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