Medical futility often stimulates intense conflicts among medical/surgical patients, their families or surrogates, health care staff, medical–legal–financial systems, and ethical standards, including the allocation of scarce resources. These conflicts may be particularly intense when the patient is uncooperative or provocative (Groves 1979). Consultation-liaison (C/L) psychiatrists frequently are asked to help resolve such conflicts. The C/L psychiatrist is a member of the medical/surgical team who works directly with the patient and his doctor (i.e., consultation) and also influences the team's decisions through interactions with the rest of the patient's caretakers (i.e., liaison).
Specifically, the C/L psychiatrist (Strain and Grossman 1975):
Identifies patients at risk of or evidencing psychiatric or psychosocial difficulty
Treats patients in conjunction with the medical/surgical/nursing team
Suggests appropriate follow-up and aftercare of psychiatric problems
Addresses staff conflict(s) over patient care
Because of their background and experience in understanding human behavior, C/L psychiatrists are accustomed to dealing with conflicts relating to medical futility. Although each medical situation is unique, situations of futility have in common that the individuals involved have been deprived of a basic emotional tool, that of taking action. Being able to act effectively in the world provides a person with an outlet for aggression and is associated with feelings of confidence, self-esteem, independence, and safety. When effective action is impossible, as in a situation of medical futility, the individual may feel frustrated, angry, and vulnerable. Conflicts involving aggression frequently surface strongly.
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