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A Prospective Study of Physicians' Preferences and the Clinical Course of Hospitalized Patients

Mary E. Charlson, MD; Frederic L. Sax, MD; C. Ronald MacKenzie, MD; Suzanne D. Fields, MD; Robert L. Braham, MD; R. Gordon Douglas, Jr, MD

JAMA. 1986;255(10):1316-1322.

Abstract
Physicians have to address the question of the measures to be employed in the event that a patient's condition deteriorates after admission to the hospital. To identify the information that physicians use in making such decisions, all 604 patients admitted to the medical service during a one-month period were studied. The patient's age and residents' estimates of the patient's long-term prognosis and ability to function were the three primary factors that correlated with intervention preferences. When illness severity, the reason for admission, comorbidity, and poor function were taken into account, mortality and morbidity rates did not differ between patients for whom full vs not-full intervention was favored. Apart from differential rates of admission to critical care units, there were no important differences in the care, course, or mortality of patients for whom less than full intervention was initially favored. Suggestions that physicians should discuss resuscitation with all or most patients who may die are unrealistic. A more prudent strategy is to discuss the issue with patients whose hospital course is marked by a steady deterioration.

(JAMA 1986;255:1316-1322)

Author Affiliations
From the Clinical Epidemiology Unit, Division of General Internal Medicine, Department of Medicine, Cornell University, New York. Dr Sax is currently a fellow of the National Heart, Lung, and Blood Institute.

Footnotes
Reprint requests to 1300 York Ave, New York, NY 10021 (Dr Charlson).

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