Differential Medical and Surgical House Staff Involvement in End-of-Life Decisions: A Retrospective Chart Review

To quantify the house officer's role in end-of-life decisions, the authors abstracted charts for documentation of end-of-life discussions for 100 patients withdrawn from life-sustaining treatment. They assessed the proportion of end-of-life care notes written by house officers, controlling for service, length of stay, outpatient physician involvement, race, and diagnostic category. Patients on the medical service were 22 times more likely to have house officer end-of-life notes than patients on the surgical service (P < 0.00001). Sixty-one percent of medical patients and 10% of surgical patients had a do-not-resuscitate note written by a house officer (P < 0.00001). House officers on the medical service wrote a significantly greater proportion of notes regarding withdrawal of care than surgical house officers (41% vs. 10%, P < 0.00001). This study reveals extensive involvement of medical house officers in primary end-of-life discussions with a complex patient population undergoing withdrawal of life-sustaining therapy. Team structure and professional culture may account for some of the observed differences between the medical and surgical services. These findings have significant implications for the education of house officers on end-of-life communication.