Schiavo case shows need for clarity.(research)(care and treatment)

The case of Terri Schiavo serves as a lesson for physicians: Make sure you explain things in terms that patients and families can understand.

From what I have read and heard, it is clear that Ms. Schiavo was in a persistent vegetative state (PVS) with no chance for any kind of recovery. It also is clear that her parents did not want to believe that this was so. What is unknown, however, is whether Ms. Schiavo's physicians were able to adequately explain to her parents the true nature of her condition.

Doctors have a bad habit of speaking in jargon to patients' families, using the same kind of phraseology they use with their colleagues. And physician culture is driven all too often by money. When the "invisible taxi meter"--billable time--is running, physicians will spend time with patients, but at other times, such as when they're doing paperwork, reviewing records, or calling patients on the phone, the meter is off.

Being only human, doctors sometimes will give short shrift to this part of their job because they want to get on with making money again.

As the last remaining charter member of my hospital's ethics committee, I like to remind people that we're making enough money when the meter is on, and we should do just as good a job when the meter is off. It's our duty. I see too many doctors ignore that notion.

Doctors need to let families know exactly what PVS patients are going through. Estimates are that there are between 10,000 and 25,000 patients who are in a vegetative state living in nursing homes around the country, and maybe another 200,000 people in a "minimally conscious state;" physiologically, they're functioning at a higher level with some cognizance, but they're still helpless.

For example, a minimally conscious patient may weep in the presence of a family member but not in the presence of staff.