Conceptualisations of medical practice as ‘saving lives and warding off death’
| Description | Examples |
|---|---|
| Dominant cultural, economic construction of hospitals, doctors, medicine as being officially about saving lives: warding off death, not overseeing the dying. | ‘I think one of the things that's important is we go into this profession and, you know, doctors it's all about we need to fix things, and we need to, you know, cure things. That's kind of the mindset we have. And we sometimes lose sight of the fact that we can't actually fix everything.’ (Staff physician) ‘It's as though for the physicians it's always life at any cost. Always. They are always focused on saving lives. Death is like a failure. It's not something we talk about.’ (Nurse) ‘One of the daughters was angry. She was saying we were abandoning her mother. That we weren't allowed to do that. That we had to keep it up until the end.’ (Nurse) |
| Discussions avoided until life-saving was not possible or death occurred | ‘It's usually a pretty clear next step. Like the person is probably hours from dying and they change them to comfort [care]. Often it's that close.’ (Nurse) ‘A lot of times when the physician is having that conversation on a medical unit, it's when things have gone badly, when things have changed, when the patient is doing poorly so the family is really distressed about how their family member is doing.’ (Nurse) |
| Discussions focused on ‘getting the DNR’ | ‘I think we get task oriented. We want to get to a goal of care because we think it's appropriate, and we just want enough from the patient to justify in our own minds that they're in agreement with that. And I'm not sure, in an informed consent way, that that's enough.’ (Staff physician) |
| Professionals’ identity wrapped up in ideas of saving lives | ‘The residents say “She's really sick, and she's not doing well.”’ “‘Yeah, but we're doing everything. We are doing everything, and the rest is because the person is failing. It's not because we're failing.” So changing that mindset from we should be able to cure everybody all the time, and nobody should ever die which is crazy, right? Doesn't make sense.’ (Staff physician) |
DNR, do-not-resuscitate.