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Surrogate Distrust of Physician Prognostication: Causing Futility Disputes

Posted Sep 22 2008 4:59am

Lucas Zier and colleagues in San Francisco published a study in the current Critical Care Medicine, in which they report (based on a small sample) that surrogates doubt the accuracy of physician's ability to prognosticate. They identified four main explanatory categories:

  1. Influence of God
  2. Inherent Inaccuracy of Predicting the Future
  3. Prior Experiences with Inaccuracy
  4. Current Experiences with the ICU
While physicians can do better with EOL communication, this study does not expose anything really surprising. All prognostication is based on past experience with similar cases. It's always an estimate. Surrogates realize that fact. And to the extent there is still a chance (any chance) they want to "take it regardless of the number."
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