When Treatments Kill
It truly amazes me how soon writers block can set in. As you can probably see, my enterprise hasn’t exactly seen a lot of throughput. LOL 😀 . Okay enough of microprocessor terminology and let’s get on to something really cool 🙂 .
Doctors are quite peculiar in the fact that they strive to kill their own profession, at least indirectly. You could say the same for police officers, firefighters and their like. If there weren’t disease, crime or fire incidents, each of these groups would have achieved their missions and would have wiped out the very purpose of their existence. In our never ending struggle with disease, we are prone to treating people. EBM has taught us that that might not necessarily be a good thing. End-of-Life care and palliative medicine have totally transformed our thinking about the very definition of the word treatment. Treatments may very well be characterized by lack of interventions. For instance, CPR (Cardiopulmonary Resuscitation) no longer is viewed as something absolutely necessary. Through EBM, we’ve come to realize that the overall success rate of CPR is a meager ~15%.¹ To many of us that sounds surprizing, doesn’t it? We also now have clearer statistical evidence on which patient groups have better vs. worse success rates. Given these statistical insights, it is perfectly reasonable in certain instances for people to be given the choice of a DNR (Do Not Resuscitate) order in their treatment plans. The risks of broken ribs, fat embolism and other complications of CPR outweigh the benefits in such cases. Similarly, maintaining full nutrition may not be that good an idea, again if it’s not contrary to the specifics of a given case (eg. the patient’s choice, etc.) . It has been found that the mild ketosis during the starved state can very well induce a sense of comfort in painful end-of-life conditions.¹ So if the patient requests not to be tube-fed, you’re not only obligated to respect this request from an ethical standpoint but from a scientific perspective as well. The list of interventions that could be withdrawn in palliative care goes on, but I don’t really want to focus on that here. In most of these situations, the primary reason for not intervening isn’t because intervening is likely to accelerate death.
Nor is this post’s intention to bring to your attention, side-effects of medications/interventions that might eventually kill. No, we are talking about entirely different beasts here.
There are rare cases when the situation at hand isn’t palliative in nature or one that has a side-effect angle to it. A couple of unique instances actually wherein, the act of intervening itself will in fact worsen a patient’s condition and likely result in death. These go in line with the medical myths we discussed in my last post. Notice how these beasts baffle your instincts. So without further ado, some of these include²:
- Infantile Botulism – an infectious process – yet antibiotics worsen the case and are contraindicated.
- Hemolytic Uremic Syndrome due to Shigella – an infectious process – yet again, antibiotics worsen symptoms and are contraindicated.
- Thrombotic Thrombocytopenic Purpura – a situation where there’s a platelet decline – yet platelet transfusions are contraindicated.
Note that these aren’t the only ones, so do watch out for others! It’ll do you and the patient a lot good!
- Current Medical Diagnosis & Treatment, Chapter. Palliative Care and Pain Management by Michael W. Rabow, MD; Steven Z. Pantilat, MD
- Kaplan Medical, Lecture Notes for the USMLE Step 1
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