Sanjay Gupta talks DNR on Colbert Report

[Prof Moriarty]

I was in the Colbert Report studio audience yesterday and Sanjay Gupta was a guest. During the taping, Dr Gupta made a couple of (what I thought were) sketchy sound-bite remarks:

1) Patients w/ DNR's get worse care than those without them.

2) Lots of nursing home patients in persistent vegetative states eventually come out of the persistent vegetative state and live normal lives.

I'm paraphrasing, but that was the gist of what he said.

I'm on a palliative care medicine rotation right now and I couldn't help cringing as he made those remarks. I'm just a student, but especially with regard to the DNR comment, this is directly contrary to what I'm being taught and what I'm witnessing on a daily basis.

Fortunately, they edited this comment out of the show that aired, but Dr Gupta looks like he's promoting a book, so I wonder if that soundbite will be repeated and eventually reach a wider audience.

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[adam6]

First of all - jealous you saw Colbert!

Secondly, I have not read his book - so I cannot assess his position completely. However, I can assess him based on the soundbites that will be reaching most people.

I heard Sanjay Gupta on NPR - also promoting his book and talking about "persistent vegetative states." Basically, he was saying that our current concept of brain death/death is inaccurate and we are often making the wrong diagnosis.

He went on to discuss a few anecdotes of individuals' miraculous recoveries from various conditions - hypothermia to other vegetative states.

While I think these cases should prompt vigorous scientific study, I think he is doing a tremendous disservice to both the medical and lay communities. By leveraging his high-profile status, he will single-handedly obstruct efforts to allow people to die with dignity (and force us to continue to systematically "torture" the elderly with unending tests and procedures). Additionally, he will heap further guilt on the loved-ones and their decision to withdraw support.

It is one thing if there are demonstrable, systematic errors in practice and/or trustworthy alternatives to current practice. However, he only made a footnote comment that the vast majority of cases are individuals who will not survive based on current technologies.

While I'm glad he gets to globe-trot and meet survivors in Scandinavia and Asia, etc --- I wish he'd step back and do more research prior to making these media statements (and writing a book). I wonder what his neuro ICU is like at Grady? Do they keep everyone on vent/nutrition indefinitely because we can't seem to diagnose brain death and they might make a miraculous recovery? hmmmm....

 

[Mike Holloway]

Perhaps someone here could enlighten me as to why Gupta is doing this. In his book, in interviews, and in ads, he is telling the public that he has personally seen patients rise up from brain death, and that brain death is just like vegetative state. Why is he doing this? Currently in the peer reviewed liturature there is a debate about a better definition of loss of the higher brain component of brain death, but nothing about a huge paradigm shift in the understanding of brain death. No one has risen from brain death. Gupta hasn't published anything in the peer reviewed liturature about patients rising from brain death. So what's going on here? Its hard to believe that its just sloppy use of terms since he does seem to understand the difference between vegetative state and coma.

 

[sgtbrushes]

I'll answer your question with one word... actually, I don't even need a word. Just a symbol.

$

 

[Hamhock]

I'll answer your question with one word... actually, I don't even need a word. Just a symbol.

$

Yeah, I agree: $.

Well, I agree with regards to the idea of brain dead (are we really still using this terminology? they're not brain dead, they're dead...I am sad palliative folks are using this term) walking out of the hospital.

However, Dr. Gupta is correct about DNR patients getting inferior and often limited care in some parts of the US. I finished med school and internship in the high NE, where the culture allowed excellent palliative practice and DNR was an order strictly followed. However, I am about to finish residency in a major US city not far from the NE and daily note how DNR is so confused with DNT (do not treat).

HH