Patient Safety at the End of Life – The Importance of “That” Conversation #1

Share this Post:

Sadly, too many patients and too many doctors and nurses do not navigate end-of-life care issues succinctly or even compassionately, and failure to do so can result in enormous distress for patients, family members and clinical staff.
This failure to discuss, to share thoughts and to candidly communicate also can result in harm and even litigation. This is especially the case when there is confusion about what has been said or agreed upon and when there is disagreement amongst family members about the best courses of action for severely impaired relatives incapable of making their own decisions1,2.
The use of advanced directives and the designation of specific individuals with powers of attorney for medical matters has helped considerably, but many, many older patients are seemingly unaware of these mechanisms. They also may be aware but have become complacent about availing themselves of these mechanisms or have remained sadly plagued by inertia, stuck in “the mud and the muddle” of indecision until a devastating circumstance or terminal illness catches them off guard.
Sometimes I think those on the front lines of healthcare—by that I mean doctors, nurses AND patients—do more to prolong dying than to sustain meaningful life. Life extension becomes the ultimate goal for many patients, even though that really amounts to prolonging the dying process, often accompanied by pain, suffering and the increased potential for harm resulting from healthcare. Collectively we need to do, and can do, much better!
I would strongly recommend all of you read Dr. Atul Gawande’s recent publication, Being Mortal. Set aside time for this as it will change your views of health, healthcare and what matters most to patients.
Case Study:
A 90-year-old woman, a personal friend, now somewhat frail and in slowly declining health for several years, had lived a wonderful, active life until her mid-80s. She suddenly developed bloody bowel movements and severe abdominal pain. She had been in good health generally, although she did have an allergy to penicillin, which later would play a significant role in this story.
Her physician had rendered a diagnosis of ulcerative colitis, although he had not done a sigmoidoscopy or colonoscopy, and imaging studies were vague and inconclusive. Ulcerative colitis presenting for the first time at this age is very unusual, and failure to consider an alternative diagnosis, mainly ischemic bowel disease, which is much more common, was the first error in this woman’s care. The second error was prescribing sulfasalazine and prednisone, standard treatment for ulcerative colitis, without a definitive diagnosis in an elderly frail patient. Prednisone is an immunosuppressant that can impair tissue healing.
Two weeks after starting therapy, my elderly friend was admitted to hospital having acutely deteriorated after a colonic bowel perforation, the onset of abdominal sepsis and ultimately septic shock with multi-system organ failure (lungs, liver, heart, kidney and brain). Most of her colon had been removed surgically on the day of admission. Whether any of her colon, or select areas of her small intestine remained functional, was uncertain. When I first saw her she was semiconscious, receiving parenteral narcotics for pain and vasopressors to support her blood pressure. She continued to have bloody feces, now from a colostomy tube, and was clearly in dire straights and heading toward death’s door. Her pulmonary insufficiency was substantial enough that ventilator support seemed inevitable, and dialysis also was under consideration. Even if there were a remote possibility that she might survive this illness, she likely would never, ever return to her usual productive and comfortable lifestyle, as her systemic vascular disease and ischemic bowel disease would ultimately cause her demise.
Decisions regarding her care needed to be made collaboratively among the family and the ICU doctors and nurses. The questions to be asked were compelling and the answers would have profound importance to this patient her daughters and her grandchildren.
  • 1. Gawande A. Being Mortal. New York, NY: Metropolitan Books, Henry and Holt and Co: 2014.
  • 2. The Conversation Project –


Leave a Comment

Terms of use

Welcome to our website. If you continue to browse and use this website, you are agreeing to comply with and be bound by the following terms and conditions of use, which together with our privacy policy govern Health Matrix’s relationship with you in relation to this website. If you disagree with any part of these terms and conditions, please do not use our website.
The term Health Matrix or ‘us’ or ‘we’ refers to the owner of the website whose registered office is Al Taown Business Center, Office 17, Riyadh, Saudi Arabia. The term ‘you’ refers to the user or viewer of our website.
The use of this website is subject to the following terms of use:

• The content of the pages of this website is for your general information and use only. It is subject to change without notice.
• This website uses cookies to monitor browsing preferences. If you do allow cookies to be used, the following personal information may be stored by us for use by third parties.
•  Neither we nor any third parties provide any warranty or guarantee as to the accuracy, timeliness, performance, completeness or suitability of the information and materials found or offered on this website for any particular purpose. You acknowledge that such information and materials may contain inaccuracies or errors and we expressly exclude liability for any such inaccuracies or errors to the fullest extent permitted by law.
•  Your use of any information or materials on this website is entirely at your own risk, for which we shall not be liable. It shall be your own responsibility to ensure that any products, services, or information available through this website meet your specific requirements.
•  This website contains material that is owned by or licensed to us. This material includes, but is not limited to, the design, layout, look, appearance and graphics. Reproduction is prohibited other than in accordance with the copyright notice, which forms part of these terms and conditions.
•  All trademarks reproduced in this website, which are not the property of, or licensed to the operator, are acknowledged on the website.
• Unauthorized use of this website may give rise to a claim for damages and/or be a criminal offense.
•   From time to time, this website may also include links to other websites. These links are provided for your convenience to provide further information. They do not signify that we endorse the website(s). We have no responsibility for the content of the linked website(s).
•   Your use of this website and any dispute arising out of such use of the website is subject to the laws of Saudi Arabia.

Privacy Policy 
Your privacy is important to us. This privacy policy is intended to give you confidence in the privacy and security of the personal information we obtain from you whether you are using Health Matrix products, uploading information to Health Matrix and our products’ websites (the “Websites”), downloading our applications, or are merely visiting our Website. 
However, please note that we are not responsible for any use of your personal information you provide to third-party applications or websites that may be accessed via the Products or Websites. We recommend that you review the privacy policy of any third-party applications or websites that you use. 
When you use our Products or Websites, you may be asked for personally identifiable information such as your name, address, date of birth, email address, and telephone number. 
By giving us such information, you will need to consent to our using it in the manner described in this policy. 
You may withdraw your consent at any time by emailing us at We will return or destroy your personal information within five days of receipt of your withdrawal of consent. 
Cookie information, pages you have requested, and your IP address may also be recorded by us and/or third parties from your browser as set out in this policy. 
Health Matrix will use performance data, including performance statistics, bug fixes, and other similar data (“Performance Data”) uploaded to our Websites or acquired through our Products. Health Matrix may use such Performance Data in any way, including, but not limited to, using, editing, altering, reproducing, publishing, and/or distributing the Performance Data for any purpose, commercial or otherwise, provided that such Performance Data is stripped of all personally identifiable information. 
We use personal information to allow us to process your service requests, provide access to privileged areas of the Websites, send out newsletters, personalize your visit to our Websites, personalize your use of our Products, and enable us to improve the products and services we offer. We may occasionally carry out market research and send you details of services and offers that we think may be of interest to you. If you do not wish to receive such information, please e-mail or, alternatively, when we send you an e-mail, it will contain a provision for you to opt-out of receiving any further information from us. 
We may provide information about you to our employees and agents in order to administer any accounts, products, and services provided to you by Health Matrix. 
We will not disclose your personal information to any third party unless you have consented to such disclosure or where we are required to do so by law. Should you breach our terms and conditions or terms of use or if we are under a duty to disclose or share your personal data in order to comply with any legal obligation, we may disclose your information to a relevant authority. This may include exchanging information with other companies and organizations for the purposes of fraud protection and credit risk reduction. Any disclosure of personal information will be strictly controlled and made fully in accordance with current Saudi Arabia law. 
Cookies are small data files that a website you visit may save on your computer or handheld device that usually includes an anonymous unique identifier. Our Websites and those of our Products may use cookies for user authentication, keeping track of your preferences, promotional campaigns, tracking our audience size and traffic patterns, and in certain other cases. We may include small graphic images in our email messages and newsletters to determine whether the messages were opened and the links were viewed. 
Third-party advertisers may also create and access cookies, which will be subject to their privacy policies – we accept no responsibility or liability for the use of such third parties cookies. If you do not wish cookies to be placed on your PC or handheld device, then they can be disabled in your web browser. The option to do so is normally found in your browser’s “security settings” section. Please note that permanently disabling cookies in your browser may hinder your use of our Websites as well as other websites and interactive services. 
All security on our Websites is treated seriously. Where applicable, we undertake security steps, including the use of SSL technology, on our back-end systems that store customer account information and protect data transmissions. However, this is not a guarantee that such data transmissions cannot be accessed, altered, or deleted due to firewall or other security software failures. 
If you have any further concerns about security, please email our Customer Service team at
Changes in this policy will be posted on our Websites. You are advised to check our Websites regularly to view our most recent privacy policy. 

If there are any questions regarding the private policy, you may contact us using the information below 

Powered by:HM Dev

Request a Demo

Social Media

Share this page
Follow us

Subscription Center

Service Management Portal