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Whose Death Is It, Anyway
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
TO THE EDITOR:
The article by Gilligan and Raffin [1] and the essay by Hansot [2] highlight a troubling but unfortunately too-frequent occurrence in hospitals today. Gilligan and Raffin express the politically correct position that the physicians caring for Ms. Hansot were motivated by their “preoccupation with the preservation of life.” References to the intensive care unit as a place where the patient may be intubated and sedated and “in which the physician–patient relationship may be reduced to a daily 2-minute physical examination” do not support this viewpoint. Rounds this brief cannot represent a desire to preserve life but rather a desire to show up to get a signature on a chart.
Care in the intensive care unit requires continuous monitoring, continuous nursing, and continuous doctoring; the latter is extremely time consuming, even in its most basic form [3]. Most of the difficulties experienced by the Hansots and Ms. Hansot's physicians would not have occurred had a physician been present in that critical care unit.
As do most other physicians, I begin my bedside visit by asking “How are you?”, regardless of where in the hospital the patient resides. If he or she is unable to answer, the critical care nurse can, in addition to providing other necessary information. The patient is then examined, and laboratory data, radiographs, and the other “numbers” are reviewed. All of this mandates that time be spent near the patient. Two minutes is hardly time enough to observe a patient from the doorway.
Our role as caregiver is not different from that of our predecessors-to comfort patients, be they healing or dying. This is predicated on serving the wishes of each patient as an individual: for some, curative intent; for others, the alleviation of suffering. The time spent in the intensive care unit attending to the constantly changing status of our patients provides us the opportunity to converse with them and their loved ones so that we understand their fears, wants, and needs.
Perhaps if we viewed the dynamic in its proper context as a patient–physician relationship we would remember whom we serve. The ailing are the masters and we, their servants.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
