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Posts Tagged ‘trade off between qulaity and quantity’

A  72 year old man in  terminal heart failure with  three previous admissions in  last one year  comes with severe breathlessness . He was  exhausted with  rigorous  drug regimens  for refractory heart failure in the past few months. Since he  was always feeling better after an infusion of Dobutamine he demanded it . Doctors were very clear  , ” Repeated  Dobutamine infusion will  hasten  the LV dysfunction and longevity is  will shorten”

The family began to think . While they  wished  for him to   live longer , the sick man  insisted  on  early  relief from his  symptoms .

How often in medicine ,   there is a trade off  between  symptoms and survival ?

It is a more common situation than we believe , especially in many  chronic  disorders like terminal organ failure and malignancies. .  So we need a simple scale to  asses the quality of life and survival  outcome for our patient. The following table  could help us . I  learnt this from   the great teacher Valentine Fuster’s  lecture  which  I attended in New Delhi recently !

Final message

Let us  attempt to  make a patient’s  life ” feel  good “ ,  if  he is going to live shorter .  Let us avoid  prolonging  a  life ,  if the treatment is making him feel  bad  , when the  life  expected  is  short !

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