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A Piece of My Mind
November 7, 2017

Despite My Best Intentions

Author Affiliations
  • 1Medical Service, Palo Alto Veterans Health Care System, Palo Alto, California
JAMA. 2017;318(17):1653-1654. doi:10.1001/jama.2017.6123

The resident looked worried and the intern was nervous. They were concerned about an elderly patient with low cardiac output heart failure. We reviewed our plans for the day, and as we entered his intensive care unit (ICU) room, it was obvious that our patient was scared. He had a rapid heart rate and an irregular pulse. His extremities were cool to the touch despite two vasopressors supporting his blood pressure. His wife sat attentively next to him. We asked him how he felt. We discussed his heart rate, blood pressure, urine output, his ever-changing medications and even the remote and unlikely possibility of a heart transplant. We assured him that he was slowly improving. They were aware of our assessment and plans. Next, we attempted to understand the patient’s longer-term concerns in the context of his illness. Given his precarious health situation, we knew that the conversation needed to be handled with great understanding and empathy.