Physician: 'I Almost Killed a Patient' Because of an Advance Directive
A Misunderstanding of the Documents
"At that time he delivered the appropriate treatment and saved her life," Mirarchi says. "I was following this paper they presented. If it wasn't for him reaming my butt, this never would have had the impact that it has with me. The lesson is, you can easily end up killing patients who have ultimately treatable conditions."
The reason lies with the misunderstanding, at the clinical level, of advance directive documents. Regardless of what patients put on these forms, they probably want to be treated for any condition for which recovery is possible, yet it's not clear to doctors and nurses what they want, and they often interpret the documents differently.
"This thing of misunderstanding of documents is hugely important," says Mirarchi, who adds that his father died of sepsis because his caregivers interpreted his advance directive—a do not resuscitate order—to mean that he was not to be treated for bedsores that developed from his incapacitation.
"My father ended up dying because of it," Mirarchi says. "They left him in a bed to the point at which he developed bedsores that became septic," which ultimately, became his cause of death.
Mirarchi subsequently discovered that there is very little research into how advance directives are interpreted, not only by the physicians and nurses treating patients, but by their own designated surrogate decision-maker, often the spouse.
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