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Old 04-14-2013, 08:03 AM   #21
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Location: midwestern city
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You do realize that you may have a duty to report unethical practices, correct?
Originally Posted by Silver View Post

and in my experience as a RN, advance directives are useless if there is money to be made.

Very conservative with investments. Not ER'd yet, 48 years old. Please do not take anything I write or imply as legal, financial or medical advice directed to you. Contact your own financial advisor, healthcare provider, or attorney for financial, medical and legal advice.
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Old 04-14-2013, 10:51 AM   #22
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Originally Posted by obgyn65 View Post
You do realize that you may have a duty to report unethical practices, correct?
Absolutely. But the health care system, including medical practice, rarely reveals itself enough to be reportable as unethical when the patient is in the end-of-life stage. Plus, the current advance directive processes are nebulous enough that they are easily overlooked in order to provide revenue-producing services that do not benefit the patient.

Let's say the patient is 80 years old and hospitalized in the final stages of congestive heart failure. Their history includes documented vertebral compression and pain for many years, and the current level of morphine being administered to control pain is effective. Advance directives are clear that they want oxygen and pain control only. Yet an orthopedic consult and CT scan for back pain are ordered when the patient is noticed to grimace when being turned. The consult and scan are completed, and the patient dies of CHF within 48 hours as anticipated.

Stuff like this, and worse, happens all the time. What seems to control it best is a family that is involved enough to step in and say "no" to anything other than what the patient has requested. It's always a judgement call on the families' part, but the health care system will usually try to sell them something that isn't helpful.

I have also seen advanced directives and DNR orders totally ignored. These are more clear cut, and always followed up with organizational risk management departments, but it still happens.

Don't look back. You're not going in that direction.
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