Doctors typically agree with surrogates' decisions on care
When medical conditions render hospitalized patients unable to make decisions about their care, responsibility typically falls on family members or friends to act as surrogates in deciding what care should be provided. A new study finds that, for the most part, physicians agree with the care decisions that surrogates make. Of the 281 physicians interviewed in the Chicago area, nearly three quarters (73 percent) made major medical decisions with surrogates in the previous month. Common joint decisions addressed palliative or hospice care, changes in code status, or life support withdrawal.
Nearly 80 percent of the physicians thought communication with the surrogate was effective, and 82 percent were satisfied with the outcome. Agreement between the physician and surrogate most likely occurred when the patients were in the intensive care unit or were older. Just 5 percent of physicians reported having conflicts with a surrogate.
Although 90 percent of patients had surrogates, physicians reported difficulty locating surrogates in 21 percent of cases. Further, physicians reported that only 10 percent of patients had living wills. The authors suggest that physicians should communicate with patients while they are lucid so they can assist surrogates later with making decisions.
Surprisingly, only 1 in 5 physicians had a previous relationship with the patient. This gap may be due in part to the emergence of hospitalist physicians or the team approach many academic medical centers take toward patient care, the authors suggest. Almost a quarter of the physicians said making decisions with surrogates caused them a great deal of stress. This suggests that negotiating decisions with surrogates may be an underappreciated cause of stress for physicians. The study was funded in part by the Agency for Healthcare Research and Quality (HS15699).
See "Physicians' experience with surrogate decision making for hospitalized adults," by Alexia M. Torke, M.D., M.S., Mark Siegler, M.D., Anna Abalos, M.D., and others in the September 2009 Journal of General Internal Medicine 24(9), pp. 1023-1028.
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