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Discussing DNRs

June 2011

Published in the June 2011 issue of Today’s Hospitalist

I wanted to follow up on your DNR article in the April issue (“DNR orders done wrong“). I always start off by telling patients, ” Do not resuscitate does not mean do not treat.” DNR is very different than comfort care.

I also give some down-to-earth facts to help patients and families wrap their heads around their real-life odds surrounding resuscitation. I tell them that patients on television have a 66% chance of a perfect recovery after being resuscitated; in real life in a real hospital, it is between 5% and 10%.

I also let them know that those who do survive are often not the same person they were pre- resuscitation. And I tell them that those who do survive are most often 50-year-old patients with heart attacks, not 80-year-old patients with 80-year-old hearts and kidneys. Finally, I remind dialysis patients and cancer patients that resuscitation survival rates for someone on dialysis or with active cancer is almost zero.

To let patients know that it isn’t my decision but theirs, I then explain that DNR preferences are very individual. Some people never would want to be resuscitated, while others would want to be “on a machine forever,” if that was the only way to stay alive.

The “code conversation” can be very difficult and needs to be done with sensitivity and compassion. However, I have yet to find a patient who is offended hearing these things. Instead, patients are always grateful to learn some facts and to be able to make more informed decisions.

Andrew Felcher, MD
Portland, Ore.

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