Better Balance

In the article, “The Patient in the Intensive Care Unit,” Robert Zussman discusses how patients tend to fade from being a individual to being a series of numbers and symptoms. As many of the patients in the ICU tend to either be very sick or unresponsive, doctors come off as not being empathetic towards the patients as they focus more on their symptoms. While I agree that doctors should be more empathetic and pay attention to the feelings and needs of their patients that may not be directly related to the patient’s symptoms, I would argue that the doctors themselves are not much at fault themselves. I believe that the doctors in the ICU are focusing their time on what is most pressing at the time: saving someone’s life. As there are only a limited amount of physicians at any given time in the ICU, doctors must allot their time carefully in order to make sure that the immediate concerns of their patient are met in order for their patient to live another day. However, there are also many accounts that the mentality of the patient is also very important in fighting sickness and recovering. As a result my question would be, “Is there a better way to balance addressing the immediate symptomatic needs of a patient with the patient’s other needs (not necessarily related to the reasons they are in the ICU for) such as the patient’s mental health?”

Solutions for ICU

In Zussman’s article about patients in the ICU, he explains two main reasons why patients seem to “vanish” in the ICU. The first is that a disease takes away a patient’s personhood. The second is that the doctors and nurses in the ICU do not care about a patient’s identity or character. He also explains how it is not the doctors’ fault because there are other serious matters at hand. Is there a way to fix these issues? Is it even possible to make a patient feel more like a person in the ICU?

Zussman also states that “medicine at its best  – at its most heroic, its purest – is about physiology and physiology alone.” Would changing this mindset be the first step into improving the ICU for patients?

Patient Care in the ICU

In Zussman’s article, “The Patient in the Intensive Care Unit”, he explains how patient’s are losing their autonomy and personhood in the ICU. Doctors in the ICU are not aiming to solve external and underlying problems of the patient’s disease or illness. The doctors in the ICU overwhelming are starting to lose their empathy towards their patients as there are many people coming in and out constantly. But, is it the doctors fault that they are not merely concern about “patient care and feelings” as their job is to save and preserve the life of their patients? There are only a certain amount of physicians within an ICU and they have to treat everyone in a small time period or it could be costly to one’s health. Others may argue that the patients autonomy and feelings should be a big part of their experience in the ICU. But does patient autonomy matter when it involves life or death? Is the patient being selfish for asking more out of the doctors time as they may be risking the life of another person in the ICU?

Prolonging Life vs. Improving Life for ICU Patients

In Robert Zussman’s excerpt, “The Patient in the Intensive Care Unit,” the issue of patient dehumanization in the U.S health care system is especially prevalent in hospital intensive care units (ICU). Zussman argues that the dehumanization of the patient results from the disease endured but also at the hands of the practice of health care professionals. Many of the people that are admitted into a hospital’s ICU with unstable vitals, but ICU doctors and nurses often work tirelessly to stabilize a patient’s heart rate, blood pressure, respirations at the expense of the patient’s personhood. Zussman made the shocking comparison of ICU medicine to veterinary medicine suggesting that there is no longer any doctor-patient communication and that the “treatment” does not require thinking of the patient at the contextual level; diseases and conditions reduce people to intubated and unresponsive vessels hooked up to organ-pumping machines. Zussman also argues that because of the lethal nature of the patient cases that they treat, ICU doctors are often less thorough in their patient’s physical examination and are less empathetic health care providers than doctors in other hospital departments. This distinct difference in treatment is demonstrated in ICU doctors coining the term “GOMER” to describe undesirable ER patients and the reduced use of talking and touch when diagnosing an unresponsive patient.

The Patient in the ICU

In Robert Zussman’s excerpt, The Patient in the Intensive Care Unit, he talks about how most patients in the ICU are unresponsive, so that the patient’s role as a participant in his/her own care disappears. The physicians’ and nurses’ main objective is to treat the existing problem rather than examine the underlying cause or address the reason for the problem. He also says that despite moral judgments exist, whether positive or negative, they matter very little: the ICU staff, for the most part, treats patients the same without regard to social judgment. In a non-ICU setting, the patient is usually a participant and less dehumanized than in the ICU. But when the patient is treated as an person, rather than “a set of numbers and dynamics”, bias and discrimination begin to play a larger role. So my question is: does the patient need to be regarded as an object rather than a person to escape social judgment in a medical setting? Does a patient’s lack of alertness and participation correlate to their not being treated with bias and discrimination? Or does time with the patient affects this, i.e. if the patients were more alert in the ICU for longer periods of time, would the ICU staff treat them differently based on social judgment?

Lack of Interest a Give and Take

In the article “The Patient in the Intensive Care Unit,” the lack of character in a patient was mentioned. The ICU is full of people with different stories and backgrounds. Sometimes the same patient comes in repeatedly, and at that point, more attention may be given to see if their habits can be changed. Otherwise, patients are treated as a number.

Nurses and doctors are too busy trying to attend to everyone to know a person fully. Rather, they can simply give them the treatment they need and move on. Is the efficiency of running the ICU and getting to every patient worth the lack of intimacy between the medical aids and the patients?

How Much Care is Really Going into the ICU?

Robert Zussman, author of  “The Patient in the Intensive Care Unit”, presents ideas about how  a patient is treated in their final moments in the ICU and how they feel being apart of this treatment. Many times, doctors are criticized for seeming to lack empathy when their patients are in the ICU, especially as this is often seen as a patient’s last moments before passing. However, it can be argued that doctor’s really can’t do anything more once their patient enters ICU, so dedicating time to them rather than somebody who could be prevented from entering the ICU would seem unnecessary. My question is, do you think that there are additional means that can be taken to ensure the patient feels comfortable (well, more comfortable) in the ICU and make their, possibly last, hospital stay easier and less depressing?

Thoughts about the lack of patient’s “personhood” in the ICU

I believe the argument about the lack of patient personhood in the ICU described in the article “The Patient in the Intensive Care Unit” by Zussman is due to a combination of factors, rather than to a single cause.

This article explains how physicians that work in the ICU usually are not aiming to solve the underlying cause of the patient’s disease. It seems to me that these physicians are concerned with a specific set of symptoms, or problems that are immediate and urgent, and are not necessarily concerned with the “broader picture” of the patient’s condition.

I do not necessarily think that doctors in this case do not care as much about their patients, or have been de-sensitized to dealing with patients everyday; I believe that each branch of medicine and medical care is to be dealt with in a different way. In the case of the ICU, patients are there because they most likely are suffering from an acute problem, that is usually the result of an existing condition or disease. Doctors in the ICU are looking to save the patient from this acute/sudden problem, so that the patient can leave the ICU alive. I can imagine how this area of the hospital can be extremely stressful to doctors, as well as to the patients and their families. Therefore, I do not think that doctors in the ICU (or at least not all of them) have become careless about their patient’s background and overall health condition, or that they want to take away the patient’s personhood; rather, I think this attitude is a product of the mindset they are obligated to be in, which is saving the patient and getting them out of the ICU alive. This is not to say that this is the right approach to patient care necessarily, but it is a consequence of how the system is set and what the expectations of the doctors in the ICU are, in my opinion.