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On Being a Doctor |

Fresh Eyes

Susan A. Glod, MD
[+] Article and Author Information

From Penn State Milton S. Hershey Medical Center, Hershey, PA 17033-0850.


Requests for Single Reprints: Susan A. Glod, MD, Division of General Internal Medicine, Penn State Milton S. Hershey Medical Center, Mail Code H106, 500 University Drive, PO Box 850, Hershey, PA 17033-0850; e-mail, sglod@hmc.psu.edu.


Ann Intern Med. 2010;153(4):272. doi:10.7326/0003-4819-153-4-201008170-00013
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The 4:30 p.m. page is hardly a welcome sound to any consultant. The prognosis is especially bleak when you are the palliative care physician on call. I tapped out the familiar extension to the neurology intensive care unit and listened to the story on the other end of the line. After a few sentences, I brightened. I had met this patient the previous month, when I was working as the internal medicine consultant and was already familiar with his case, as well as with his family. I might be able to finish the consult in an hour and still make it home for dinner.

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Fresh Eyes
Posted on August 17, 2010
Gerald Hollander
Maimonides Medical Center
Conflict of Interest: None Declared

Thank you, Dr Glod, for your "Fresh Eyes".

It has always been the case that a new and careful observer can shed light on a difficult diagnostic case. As a result, the meticulous medical student is often the team member who provides the key to unlock an elusive diagnosis.

More importantly, your essay highlights the complex decision making at end of life in an era when technologic advances allow for unprecedented prolongation of life while at the same time there has been a paradigmatic culture shift towards "comfort care", "death with dignity" and a demand for "a good quality life".

Is it not presumptuous of us to decide what constitutes a worthwhile existence and where do we draw the line? What truly is the value of each and every moment of life- even when limited? Are we not, as physicians,obligated to ply our trade to the best of our abilities to heal our patients in order to promote "recovery" - even if that means a recovery to an imperfect state of health that may be short lived?

There are certainly cases of terminal, suffering patients for whom further intensive medical care is futile and where these measures should not be applied while there there are also those, such as the patient you describe, for whom a focus on healing proves critical. May we be granted the wisdom to know the difference.

Conflict of Interest:

None declared

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