I was in a family meeting today. Part of my job definition as a doctor also means that when situation so demands I have to provide a complete and essential update to the family members of my patients. This becomes more important and tough in patients who are sedated or who are complex and do not have a definite diagnosis. But we have to do whatever is necessary to involve the family according to the wishes of our patients. It makes them feel empowered and respected and helps us run the show as a complete working team.
Anyhoo I do not mean to write about these meetings today. It is not my intent to do so because the intent of today's meeting was to determine withdrawal of care for one of my patients and the result was a not always desired one _ death.
We as doctors have great respect for numbers. Numbers determine our course of action. Numbers determine our prognosis. Numbers determine our treatment. Numbers dictate our proficiency as good doctors. We are so dependent on numbers that I feel helpless if I am deprived even for a second of my share of numbers. I can't live without the numbers screen on my epic. In fact it is the first thing that I visit on each of my patients chart every morning. I look at their vitals in the morning and overnight. I look at their ins and outs. I look at their counts and lytes. I read numbers and I interpret numbers. I make pictures out of these very numbers and I use the very same numbers to pacify my staff about the progress of my patients. It is important that the patient tells me that he did very well overnight but it is also very very important that his numbers tell me that he did well than he admits he did.
I fear numbers. They are not my patients but have a hold on my decisions about my patients. It is a scary proposition. It is scary to me not because i fear that these numbers are not prodictive of the confidence with which I see my patients but I am freightened by the fact that numbers come to the rescue of numbers. If I am to fear that certain numbers are not indicative of how my patient feels all I can do is to fall back on some other facts and figures, which are numbers, to figure out the positive and negative predicitve values of my test reults. the sensitivity and specificity of my numbers are numbers too. It is such a complex game of numbers and there is no way out. It is like a maze out there. I get lost in that maze in the morning and keep on colouring my portrait with them all day long. Until the time it is time for me to pack up bid farewell and head for home. But still some numbers are lingering in my mind. They keep on bothering me. Just yesterday I was worried about the renal functions of one of my seriously sick patients and his creatinine got stuck in my mind. The numbers kept on playing their musical chairs all night long in my dreams. To my sigh of relief the numbers in the morning undermined their predecessors from yesterday and I ended up winning one battle in this game.
These numbers bug me because I do not have enough of these random numbers on the top of my head to figure out the probabilities and possibilities and eventualities of medicine. It takes me time to figure out things. Too many complex probabilities of caution run at random pace in my small brain and just bog it down to a halt. It is just like an old computer with limited RAM that gets stuck just because windows runs too many processes on the memory. way too many for the poor computer processor to handle.
Anyhoo I do not mean to write about these meetings today. It is not my intent to do so because the intent of today's meeting was to determine withdrawal of care for one of my patients and the result was a not always desired one _ death.
We as doctors have great respect for numbers. Numbers determine our course of action. Numbers determine our prognosis. Numbers determine our treatment. Numbers dictate our proficiency as good doctors. We are so dependent on numbers that I feel helpless if I am deprived even for a second of my share of numbers. I can't live without the numbers screen on my epic. In fact it is the first thing that I visit on each of my patients chart every morning. I look at their vitals in the morning and overnight. I look at their ins and outs. I look at their counts and lytes. I read numbers and I interpret numbers. I make pictures out of these very numbers and I use the very same numbers to pacify my staff about the progress of my patients. It is important that the patient tells me that he did very well overnight but it is also very very important that his numbers tell me that he did well than he admits he did.
I fear numbers. They are not my patients but have a hold on my decisions about my patients. It is a scary proposition. It is scary to me not because i fear that these numbers are not prodictive of the confidence with which I see my patients but I am freightened by the fact that numbers come to the rescue of numbers. If I am to fear that certain numbers are not indicative of how my patient feels all I can do is to fall back on some other facts and figures, which are numbers, to figure out the positive and negative predicitve values of my test reults. the sensitivity and specificity of my numbers are numbers too. It is such a complex game of numbers and there is no way out. It is like a maze out there. I get lost in that maze in the morning and keep on colouring my portrait with them all day long. Until the time it is time for me to pack up bid farewell and head for home. But still some numbers are lingering in my mind. They keep on bothering me. Just yesterday I was worried about the renal functions of one of my seriously sick patients and his creatinine got stuck in my mind. The numbers kept on playing their musical chairs all night long in my dreams. To my sigh of relief the numbers in the morning undermined their predecessors from yesterday and I ended up winning one battle in this game.
These numbers bug me because I do not have enough of these random numbers on the top of my head to figure out the probabilities and possibilities and eventualities of medicine. It takes me time to figure out things. Too many complex probabilities of caution run at random pace in my small brain and just bog it down to a halt. It is just like an old computer with limited RAM that gets stuck just because windows runs too many processes on the memory. way too many for the poor computer processor to handle.
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