Check Up: When DNRs are too little help

Many people worry that they could get too much care in a hospital. When they're old and frail, they may not want doctors pounding on their chests to restart their hearts or attaching them to machines that help them breathe.

Such fears have helped fuel the rise in Do Not Resuscitate (DNR) orders and living wills.

But Ferdinando Mirarchi, an emergency medicine doctor at UPMC Hamot in Erie, thinks people should also worry about the opposite problem: that the documents will keep them from getting care they actually want.

"I think this is a very underreported problem," he said.

He led a study, published this month in the Journal of Emergency Medicine, that found widespread confusion among medical residents and experienced doctors about how to interpret living wills and DNRs. Large numbers seemed to think that the two meant the same thing, and that people who had DNRs wanted the kind of comfort care associated with hospice.

Living wills are usually documents that outline the kind of care people want when, and only when, they are terminally ill and unable to make their own decisions and more treatment would only prolong their deaths. A DNR order says the patient does not want to be resuscitated if his heart stops.

Mirarchi's team surveyed 768 medical residents and faculty members at training centers in 34 states. Twenty-two percent said patients with a living will should be "full code" or get all-out care and 36 percent said patients with DNRs should get "full care" or everything but resuscitation. Both numbers should have been 100 percent. The answers improved when the doctors were given descriptions of the patients and when their code status was specified.

Mirarchi, who became interested in the subject as a beginning doctor when his own confusion almost harmed a patient, thinks medical workers need better training so they understand that living wills are not DNRs and that Do Not Resuscitate does not mean Do Not Treat. Because of the confusion over DNRs, he suggests telling hospital staff that patients want "full code," "full care" (a term he coined to mean full code except for cardiac arrest), or "hospice/comfort care." Patients should make sure they discuss their wishes with their families. - Stacey Burling