Thursday, September 24, 2015


I just had a very long phone conversation with a friend trying to figure out what to do with a mutual patient.  She is the patient's attending, and I the consultant, and we were stuck deciding between two similarly bad alternatives.  Pick option A, and the patient might die.  Pick option B, and the patient might still die.

We discussed whether there were other options for treatment (none that we could see).  We debated the pros and cons of each option (essentially equal).  We tried to think of similar cases we had seen that could possible guide our decision (none that either of us had seen).  In the end, after applying all of our cumulative knowledge and wisdom and experience to the case, we essentially flipped a coin.

And it feels terrible.  It feels terrible that there is no clear answer to this difficult question, and it feels terrible knowing that we are the ones who are responsible for this decision.  There is no longer an attending who takes responsibility for everything.  We are the attendings now.  And at times it is completely and utterly terrifying.


  1. What about the patient? I agree you are responsible to come up with the alternatives and present them to him, with all the pros and cons. But shouldn't the patient be consulted? Maybe his values and vision of his quality of life would make the choice obvious (or not). I am not even in clerkship yet and still full of idealism, but isn't the patient has a voice in this, and his share of responsibilities as well?

    1. Absolutely patients should be involved in the decision making process as much as possible, and I usually try very hard to do so, but this was unfortunately a decision that had to be made by the medical team for a number of reasons. (It would be clearer if I didn't have to respect patient confidentiality!)

  2. I miss your posts! Hope you start blogging again soon and that everything is ok!

  3. Liana - Thanks for the kind comment! Things are well, but busy. I've been feeling too tired in the evenings to write anything. Hopefully I'll be motivated again soon.