Intensive care: Do no harm

Published: Saturday, December 10, 2011, 11:17 AM

By Guest Columnist Charlie Phillips

Three of 10 males and 2.7 of 10 females will suffer a critical illness before age 65. As our baby-boomers come of age this then represents a paradigm shift in health care delivery in this country. We expect to see huge numbers entering intensive care units in the next two decades, something as a physician specializing in critical illness gives me great pause. It does so not just because of the strain it will place on our resources but the focus it puts on the limitations of critical care medicine itself. Unrealistic expectations as to our ability to heal abound both within the medical community and in the public at large. I see the potential for a lot of unnecessary human suffering, as well as wasted resources, due in large part to these expectations and our approach to critical illness in general.

There is no conquering of disease in critical illness, although many have trouble grasping that - caregivers and the public alike. About the best we can do is promote health - allow the body time to heal itself - and even that we do poorly. Critical illness is in large part an iatrogenic disorder - almost everything we do causing complication and at least some degree of harm in these very fragile patients. This should give pause and insight into the crudeness of our tools and humble - deeply humble. Unfortunately it only too often, does not. Despite persistently abysmal outcomes and the degree of human suffering our interventions cause to all involved - many in medicine and the public at large find a way to remain impressed with the machines, the drugs, the approach to illness - with themselves and their ability to control, to alter, to do. But whether our interventions are influenced by ego or 'kindness' it simply cannot be forgotten that everything we do - everything - has the potential to harm.

Until the day arrives where our tools match the complexity of human pathophysiology and can actually heal we simply must remember how crude our tools and our ability to heal really are. We must always remember we possess the ability to prolong the dying process and to increase human suffering unnecessarily. We are not here to conquer disease, conquer pain, conquer suffering - we are here to - with humility and respect for our limitations - promote health and limit harm. We should do so aggressively and with all our effort when appropriate. But we should also always know there will be times where that will not be enough and to recognize when it is time to stop.

Charlie Phillips lives in Southwest Portland.