There is nothing worse for the family of critically ill patients to receive contradictory information from different physicians. It causes an obvious distress among family members and very often leads to a “whom to believe” situation.

Situations like that are not uncommon when the patient after a complicated surgical procedure becomes critically ill and is being admitted to ICU. Sometimes, when recovery is unlikely and the patient or the family is requesting withdrawal of care, the surgeon declines to proceed to comfort measures only approach and insists on aggressive treatment.
Intensivists and Hospitalists taking care of these patients in ICU are often caught in the “crossfire” between family members and the surgeon.

A very interesting study conducted in Wisconsin and published in the Critical Care Medicine Journal examines the process of a surgical “buy-in”, or the nature of the contractual obligations between surgeons and their patients.

The authors describe the potential “obstacles” towards accepting the withdrawal of care by the surgeon. The feelings of guilt and failure by the surgeon in a case of an unexpected poor outcome were likely contributing to the failure to accept it. A poor outcome after an elective procedure had an even heavier emotional toll. This was in contrast to the medical doctor who often views a failure of treatment as failure of the patient or disease to respond to therapy.

Surgeons often assume, according to this study, that obtaining consent for the surgery could be viewed as a surrogate for bi-directional contract, with the patient agreeing to adhere to the postoperative care even if complications occur.

In my practice I have had to deal with situations when the patient is dying, yet the surgeon is refusing to accept the inevitable. Ultimately, it is the patient who is suffering, having to go through unnecessary and often futile treatment.

On the flip side of this problem, I cannot claim that I am always right and the surgeon is just refusing to see the obvious. I have been wrong about the outcome before and having somebody on the team with an opposite view on the outcome might, actually, be a good thing. After all, medicine is not an exact science.