Being a physician must be a tough profession, especially if you’re working in the ER. I wouldn’t know, but I can’t imagine there is anything worse than talking to someone one minute, and then watching their dead corpse shrivel up a moment later. And then to have that happen on a daily or even hourly basis is probably not something the majority of us could ever deal with.
Unfortunately, it comes with the job. It’s just something doctors have to find their own way of dealing with. But what is also unfortunate is that it’s not always death that is the most disturbing or traumatic part of being in the medical profession, it’s often the decisions that need to be made which can and do lead to death(s).
Medical Triage
A term that originated on the battlefield, triage is the evaluation of patient conditions for urgency and seriousness, and establishment of a priority list for multiple patients.
Every hospital is faced with triage everyday. It’s the process of deciding the order in which to treat patients. Most of the time this task is relatively straight forward; if someone is bleeding to death, it’s obvious they should be given treatment ahead of someone with a broken thumb or injured muscle.
But what happens in a crisis? What if all of a sudden twenty patients of varying ages flood the ER needing immediate medical treatment in order to survive, how do you decide who to save?
At this point you could say it’s logical to treat the children first because they have only just begun life, and are essentially the future of our society. On the other hand you could say children are much weaker, and it would be more effective to tend to someone who may respond better to treatment. But what happens if you let a child survive but not their parents? By doing that, you would be destroying a family and potentially ruining a child’s life. And by saving the parents you are denying treatment to others (possibly other children) who would have otherwise survived. And by not treating the parents nor the children, you could be wiping the family’s future existence off the face of the earth, just like that.
That’s tough.
To make matters worse, lets say you have come across two patients of a similar age and you can only save one of them. Then what? Do you save the one on the left because he’s closer, or the one on the right because he wears a Rolex? How on earth do you decide… Flip a coin? Roll a die?
If you decide not to treat either, and instead move on to one of the many other equally ill patients; is that fair? Is it fair to deny a patient’s treatment simply because it was too hard to decide which one to save? What if you knew one of them? Sure, that would make the decision easier in the short term… but what about the long term guilt of indirectly causing the death of a mother or father because you decided to save Mr. Drunk from the party you went to last weekend.
My point is: what do you think is the best way of rationing out treatment to patients needing immediate medical care if normal determining factors (such as age, vital signs or previous medical history) can’t be used to fairly give priority to one patient over another?
I’m sure some would prefer if the doctor made the decision based on instinct, others may rather trust their fate with a computer’s random output.. but one of the more interesting concepts I’ve heard is the idea of having a computer make the choice based on the patient’s calculated success or achievements (based on factors such as occupation, annual income or credit rating).
Bottom line: I know, you are probably sick with an overdose of rhetorical questions by now, but this is one topic I am really curious to see what people have to say. Please leave a comment below, and tell us what you think is the appropriate method of triage when two similarly aged patients with equal chances of survival need treatment.
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