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Refusal of Curative Care in the ED

Refusal of Curative Care in the ED

Resuscitating and stabilizing acutely ill or injured patients is a top priority for ED personnel, but traditional aggressive approaches to care may sometimes not suit the needs of those with advanced chronic illnesses who present to the ED with critical or terminal events. When seriously ill ED patients decline care targeted to cure disease, it may be challenging to rapidly shift treatment plans, especially if physicians feel unprepared and untrained for such scenarios. Framing the Conversation “When managing seriously ill patients who refuse curative care, it’s important to consider patient decision-making capacity,” says Sangeeta Lamba, MD. Pertinent information and options, including the risks of refusing care, should be provided. Ideally, patients will be able to communicate that they understand this information and verbalize their rationale for refusal based on personal goals. “It’s also important to involve the patient’s family, surrogates, or healthcare proxy,” adds Dr. Lamba. With clinical deterioration, patients may lose their ability to communicate. Others can then assist with decision making, especially if they know what patients value. “ED clinicians should first discuss overall patient goals and values before addressing specific procedures or issues,” Dr. Lamba says. “This information can help physicians frame future conversations and treatment plans to achieve patients’ objectives. It’s vital to understand the ‘why’ behind patient refusal and to use appropriate language and tone when having such conversations.” The ED team should also present viable alternatives if optimal treatment is not desired by patients or their family. Handling Transitions Once goals are clarified, patients may need to be shifted from curative care to a comfort-care approach. This transition must occur seamlessly and be...
APA 2014

APA 2014

New research is being presented at APA 2014, the 167th Annual Meeting of the American Psychiatric Association, from May 3-7 in New York City.   Meeting Highlights Transcranial Magnetic Stimulation for GAD Predicting Length of Stay in Bipolar Disorder Post-AMI Outcomes in Psychiatric Patients Mental Health Outreach Teams in the ED Psychiatric Manifestations of K2 Intoxication Suicide Attempts: Comparing ICU & ED Patients Analyzing Patients Seeking Emergency Psychiatric Care Psychiatry Resident Experiences in the ED   News From The Meeting Murder: Another Ambien Side Effect? Depot Drug Keeps Schizophrenics Out of Jail Seroquel XR Helps in Borderline Personality Disorder Antipsychotic Scrips Climb, Then Drop Pot Overuse Plus Psych Issues May Signal Trouble Unemployment Biggest Predictor of PTSD Symptom Severity TMS Cost-effective for Resistant Depression ‘Love Addiction’: Biology Gone Wrong? Private Schools: Protective Against Suicidal Behaviors? Syrian Refugees Shed Light on PTSD Risk Factors Online Sex Supplements Linked to Serious Psychoactive Effects Nonstimulant May Provide Rapid Relief for Adult ADHD Brain Abnormalities Linked to ‘Internet Addiction’ Excessive Tanning: Marker for Depression, Suicidal Behavior? Simulated Patients Teach Real Lessons in Managing Agitation Prosuicidal Posts on Instagram ‘Alarming’ Psych Outpatients Happy to Monitor Mood Via Smartphone Apps Annual Meeting:  New Research Press Briefing APA Meeting Highlights Mental Health Biology APA Annual Meeting to Highlight Integrated Care Vice President Biden to Address APA Annual Meeting What’s Hot at APA 2014?   More From the Meeting About the Meeting Registration Housing & Travel Full Scientific Program & Poster Program Topical Tracks Courses & Master Courses Joe Biden’s Address to APA Annual Meeting Annual Meeting App Schedule at a Glance Evaluation & CME Certificate Events...

Controversy Over BMJ Paper Hints at Print Medical Journal Demise

By now, you must be aware of the Canadian mammography study that appeared in the BMJ last week. It found that “Annual [screening] mammography in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination or usual care when adjuvant therapy for breast cancer is freely available.” And there was an associated risk of overdiagnosis. It was a randomized prospective trial involving almost 90,000 women over a 25-year period. The full text is here. Just about everyone, supporter or critic, has weighed in with an opinion about the paper. Here’s a different take. Earlier this month, I gave a talk at the Academic Surgical Congress in San Diego. The subject was “Social Media and Innovation in Surgery.” In it, I speculated about the probable demise of the traditional printed medical journal. I cited some experts who have deplored the current method of peer review of papers. I suggested that because of its immediacy, online peer review would emerge as the standard. While you might not think of the BMJ as social media, it does have an online rapid response system allowing letters to the editor to be published immediately, eliminating the usual delay of several months. If you look at the rapid responses, you will note that there are two major criticisms of the mammography study. One is that the mammography machines used were possibly not of the highest quality. Others have said that any study that lasts as long as the Canadian study will be subject to criticism about technology or techniques. If that disqualifies this study, then there is no point in...
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