Protectiveness

What I've noticed on this rotation is that everyone is so protective of both pre- and post-transplant patients. Since organ transplants are so high stake and often involve chronic diseases, patients' families have learned all about the process and advocate strongly for their loved ones. Most of the time this is great. Families work with doctors, they help patients get to their appointments, they are invested in patient education. They know the history well, they take meticulous details, they ask relevant questions. Doctors, too, are incredibly invested in their patients. On this service, we are far extremely conservative. We keep patients in the hospital longer, we prescribe antibiotics "just in case," we order tons of labs.

But on the other hand, this sort of behavior can be detrimental. I've had a few patients where families try to control the care so much that they are harming their loved ones. They lose the objectivity of what's going on, and their personal beliefs spill over to patient care. They request procedures that may be dangerous, insist on medications that aren't indicated, ask for tests we wouldn't normally send, and decide on code statuses which may be inappropriate. This is very scary because it's hard to persuade dedicated family members who've been by the patient's side through the transplant process. Likewise, physicians who are too protective of patients can cause their patients harm. Keeping a patient in the hospital when they don't need to be here can lead to nosocomial infections. Drawing blood for unindicated tests leads to iatrogenic anemia and higher costs of care. But in the end, we are very protective of these patients for whom we've invested so much time, care, money, tests, and an organ.