"Failure to Diagnose Dying"

Maureen Cahill MCahill at NCSBN.ORG
Wed Jun 14 15:23:20 UTC 2017

Ruth, you would be surprised to learn how often that staff also recognizes how close death is, but avoid addressing it.  Sometimes that is because such a discussion is left to one person who is "in charge" of the care and who may be taking cues from the patient or family or relying on a discussion held at a previous time.  This is the very reason why many facilities and practices try to introduce palliative care so much earlier in the course of treatment.  Their focus is on managing the symptoms that are experienced and helping to keep the conversations going about the benefits and risks of treatment all along the way.

Maureen Cahill [Senior Policy Advisor] 312.525.3646 (D) mcahill at ncsbn.org<mailto:mcahill at ncsbn.org>
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From: Ruth Ryan [mailto:ruth at RYAN-GRAHAM.COM]
Sent: Wednesday, June 14, 2017 9:20 AM
Subject: [IMPROVEDX] "Failure to Diagnose Dying"

I just read in the current issue of Improve Diagnosis that the Australia DEM Conference had a speaker on this topic.

I am very interested to know if this means what I think it means.

I had a dear friend and co-worker die of a nasty cancer in hospital.  In her final weeks, her body was blown up like a balloon while IVs filled her with more fluids.  Her mouth was cracked and dry; she couldn't eat; she didn't want to be alone.  Her family, friends and I shared time sitting with her; some had flown in.  We all could clearly see she was dying.  The physicians and nurses treating her seemed to be the only ones who had not noticed this.

They continued futile cancer treatment. Melinda complained of fear and anxiety plaguing her in the night, but the doctor refused to treat her anxiety until a psychiatrist could be consulted (and then doled out Ativan with the proverbial eyedropper). Her requests for pain medication were refused day and night because "it's not time yet", "it's not due for another hour and 40 minutes".

After a terrible final weekend like this, the chief resident came in on Monday (these decisions seem to be reserved for Mondays in teaching hospitals), talked with Melinda and agreed to stop treatment and send her to hospice.  Ten minutes later Melinda closed her eyes and passed away.

This is what I understand to be failure to diagnose dying.  Is this what is generally meant?



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