The Dilemma by Ted Bacharach MD (retired)


We had just settled down after a delicious meal when the telephone rang and the doctor on call was wanted. Fortunately, it was not me but the doctor whose home I was visiting. The doctor was on-call for a colleague.  It is always difficult covering for another physician. The call was from a nursing home regarding a 87 yr old male patient. He had been a patient in the nursing home for two years and had “gone bad” earlier in the evening. The question was, should they send him back to the hospital or keep him comfortable?  Two years earlier the family had requested “no heroics”. but on this evening the wife was visiting and wanted everything done.  She changed her mind because she wanted him to make it to Christmas ,which was still eight days away. She remarked that he had always enjoyed Christmas so much and she felt obliged to do everything to keep him alive till then.

The dilemma for my doctor friend was to come up with the proper decision.  The options were to send the patient to the hospital so he can be intubated and kept alive,  give him an extra dose of some medication to keep him there or, lastly, try to talk to the wife about the decision she had made two years ago.

The results of a wrong decision could result in a malpractice suit.

My conclusion was that it was great to be retired.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  5 comments for “The Dilemma by Ted Bacharach MD (retired)

  1. Kathy Wire
    June 15, 2013 at 8:49 am

    The problem is the two years between talks at this gentleman’s age. This is an ongoing process, and the home shares it with the patient’s physician. Quarterly care plan meetings should include a reach-out to the family about his ongoing condition, and a short discussion of how that might play out. A formal documentation of their wishes is a good platform for that discussion.

  2. william brown
    June 14, 2013 at 12:05 pm

    Seems to me to be a no-brainer: call in the family, set up a small Christmas tree, give the gentleman a gift of family warmth, laughter, carols and may be a gift he might be able to still enjoy while still sentient.

    • Kathy Wire
      June 15, 2013 at 8:47 am


  3. J. R. Johnson
    June 12, 2013 at 12:25 pm

    The patient’s insurance company probably had a pre-authorization requirement for what ever decision was made….

  4. Pat
    June 9, 2013 at 12:02 pm

    Too bad no one knew what the patient wanted.

Comments are closed.