Practice
C orner DNR,
but
Business
Richard
as
S. Heilman,
Richard
S. Heilman,
Usual1 MD
MD.
chart.
The
DNR
status
year-old
where Few
subjects
generate
not resuscitate” hospitals since
(DNR)
debate
policies
ly unknown
before
died
in the
the
early
hospital,
than
“do for
ium
all
of 1 989 We are that was essential.
1 960s.
that
the
mandated
federal legislation struggling with an issue
all now you
more
was
Before
then,
it, unless
if
you
were unlucky enough to collapse near a doctor who began open chest resuscitation. Closed-chest cardiac massage changed all this when it was demonstrated that cardiac output could be maintained without opening first defibrillator
the
chest.
the time
learned the meaning Cardiopulmonary
and
Shortly
arrived, discovered what
dying
in the
thereafter,
and medical a microwan
of “stand resuscitation
hospital
back.” (CPR)
was
changed
was
of
born,
forever.
CPR has become so common that virtually every hospital death is managed by the code team, and CPR is even mandated by law in some states unless
the patient has indicated effort should be made. families
have
have
consulted
decided
status.
in advance Such patients
that
With
with
they
their
want
exceptions,
that no such and their doctors
and
to be assigned
these
patients
vanced (often terminal) , chronic life has become so unendurable
DNR
have
illnesses, that they
CPR would be futile and inhumane. As a radiologist, I had only a theoretical in all this until I unwittingly participated successful along with
resuscitation his family,
status
but
cated
these
found
interest in the
his
doctor
had
to the rest
not
communi-
of the team
or the
terms:
Editorials
RadioGraphics I
From
mont,
the
1991; Department
1 1 1 Colchester
ed October C RSNA,
324
U
16,
1990.
#{149} Radiology
and
patient,
quadriplegic
failed
in head
had
to establish
he also tongs
a cardiac
examination
sent
80-
to radiology,
arrest
could
a
the
before
a bar-
be performed.
Since then, I take great interest in DNR status. I am intrigued by the number of DNR status patients whose well-intentioned doctors have taken the time and trouble to discuss such sensitive matters with their patients and families and yet still conduct business as usual when it comes to ordering diagnostic tests. The computer team at the hospital assumes me that it is possible to generate a list of all diagnostic tests ordered for DNR status pabut
the
list
has
not
been
produced.
not give the data I have informally on DNR status patients undergoing except to say that it is surprising cians see no contradiction futile and inhumane and as if a good outcome can
I will
accumulated barium studies,
how many clinibetween declaring CPR ordering diagnostic tests, be expected if only
enough studies can be performed. I am not talking about the 70-year-old birdwatcher recently back from the Pribilofs who has asked for DNR status because of what he or she has heard about what is done to people in the hospital. I am talking about the poor souls for whom the race is well and truly run, and whose family has asked for comfort care only, but who get thrust into the diagnostic macistrom,
DNR
status
notwithstanding.
should a list
agree
on
status
patients
sit
down
with
clinicians
of tests that are appropriate who are requesting only
and
for comfort
DNR
Al! other studies should be negotiated on a case-by-case basis. In this negotiation, the radiolocare.
gist should outline degree of difficulty
to the
requesting
physician
the
(read inhumanity) and the dollar cost of the extraordinary test and, as Mrs Reagan was fond of advising, be prepared to “just
Index
not only the
the patient
Radiologists
of an elderly patient who, thought that he had DNR
that
wishes
ad-
and believe
for
enema
tients,
the
residents was and
doctor
say no.”
radiologists
1 1 :324 of Radiology, Aye, Address
Medical
Burlington,
VT 0540
reprint
Center
Hospital
1 . Received
requests
to
the
of Verand
accept.
author.
1991
RadioGraphics
U
Heilman
Volume
11
Number
2
C orner DNR,
but
Business
Richard
as
S. Heilman,
Richard
S. Heilman,
Usual1 MD
MD.
chart.
The
DNR
status
year-old
where Few
subjects
generate
not resuscitate” hospitals since
(DNR)
debate
policies
ly unknown
before
died
in the
the
early
hospital,
than
“do for
ium
all
of 1 989 We are that was essential.
1 960s.
that
the
mandated
federal legislation struggling with an issue
all now you
more
was
Before
then,
it, unless
if
you
were unlucky enough to collapse near a doctor who began open chest resuscitation. Closed-chest cardiac massage changed all this when it was demonstrated that cardiac output could be maintained without opening first defibrillator
the
chest.
the time
learned the meaning Cardiopulmonary
and
Shortly
arrived, discovered what
dying
in the
thereafter,
and medical a microwan
of “stand resuscitation
hospital
back.” (CPR)
was
changed
was
of
born,
forever.
CPR has become so common that virtually every hospital death is managed by the code team, and CPR is even mandated by law in some states unless
the patient has indicated effort should be made. families
have
have
consulted
decided
status.
in advance Such patients
that
With
with
they
their
want
exceptions,
that no such and their doctors
and
to be assigned
these
patients
vanced (often terminal) , chronic life has become so unendurable
DNR
have
illnesses, that they
CPR would be futile and inhumane. As a radiologist, I had only a theoretical in all this until I unwittingly participated successful along with
resuscitation his family,
status
but
cated
these
found
interest in the
his
doctor
had
to the rest
not
communi-
of the team
or the
terms:
Editorials
RadioGraphics I
From
mont,
the
1991; Department
1 1 1 Colchester
ed October C RSNA,
324
U
16,
1990.
#{149} Radiology
and
patient,
quadriplegic
failed
in head
had
to establish
he also tongs
a cardiac
examination
sent
80-
to radiology,
arrest
could
a
the
before
a bar-
be performed.
Since then, I take great interest in DNR status. I am intrigued by the number of DNR status patients whose well-intentioned doctors have taken the time and trouble to discuss such sensitive matters with their patients and families and yet still conduct business as usual when it comes to ordering diagnostic tests. The computer team at the hospital assumes me that it is possible to generate a list of all diagnostic tests ordered for DNR status pabut
the
list
has
not
been
produced.
not give the data I have informally on DNR status patients undergoing except to say that it is surprising cians see no contradiction futile and inhumane and as if a good outcome can
I will
accumulated barium studies,
how many clinibetween declaring CPR ordering diagnostic tests, be expected if only
enough studies can be performed. I am not talking about the 70-year-old birdwatcher recently back from the Pribilofs who has asked for DNR status because of what he or she has heard about what is done to people in the hospital. I am talking about the poor souls for whom the race is well and truly run, and whose family has asked for comfort care only, but who get thrust into the diagnostic macistrom,
DNR
status
notwithstanding.
should a list
agree
on
status
patients
sit
down
with
clinicians
of tests that are appropriate who are requesting only
and
for comfort
DNR
Al! other studies should be negotiated on a case-by-case basis. In this negotiation, the radiolocare.
gist should outline degree of difficulty
to the
requesting
physician
the
(read inhumanity) and the dollar cost of the extraordinary test and, as Mrs Reagan was fond of advising, be prepared to “just
Index
not only the
the patient
Radiologists
of an elderly patient who, thought that he had DNR
that
wishes
ad-
and believe
for
enema
tients,
the
residents was and
doctor
say no.”
radiologists
1 1 :324 of Radiology, Aye, Address
Medical
Burlington,
VT 0540
reprint
Center
Hospital
1 . Received
requests
to
the
of Verand
accept.
author.
1991
RadioGraphics
U
Heilman
Volume
11
Number
2
