Shades of blue: the negotiation of limited codes by medical residents.
One of the most difficult decisions facing physicians in contemporary medical practice is whether to initiate or withhold cardiopulmonary resuscitation (CPR) for patients who are critically ill. Because of the problems surrounding these decisions, hospital guidelines have recently been developed for the appropriate use of do-not-resuscitate (DNR) orders. Despite the establishment of these guidelines, problems with the application of DNR orders remain. This study examines one strategy used by internal medicine resident physicians to cope with the problematic nature of decisions regarding resuscitation--the use of partial or slow resuscitation attempts, known as 'limited codes.' It analyzes how these code efforts play a role within the context of resident work by enabling residents to circumvent ethical and practical dilemmas created by the circumstances of their clinical practice.
Muller
J H
JH
Department of Family and Community Medicine, University of California, San Francisco 94143.
D000223:Adaptation, Psychological; D001291:Attitude of Health Personnel; D003220:Conflict, Psychological; D003657:Decision Making; D034462:Dissent and Disputes; D004992:Ethics, Medical; D005069:Evaluation Studies as Topic; D005190:Family / Q000523:psychology; D006126:Group Processes; D006801:Humans; D007388:Internal Medicine / Q000592:standards*; D007396:Internship and Residency / Q000592:standards*; D007407:Interviews as Topic; D008505:Medical Staff, Hospital / Q000523:psychology*; D017008:Negotiating; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011340:Problem Solving; D016414:Resuscitation Orders; D018570:Risk Assessment; D012941:Social Responsibility; D012945:Social Values; D013315:Stress, Psychological; D028761:Withholding Treatment