05:51pm Sunday 20 October 2019

Chronically Critically Ill: Penn Physicians Discuss Patients' Regrets About Medical Decisions

PHILADELPHIA — In a new Perspective essay appearing in the November 8th issue of the New England Journal of Medicine, two physicians from the Perelman School of Medicine at the University of Pennsylvania, discuss unique challenges faced by patients and their families in decisions to undergo major medical and surgical procedures.

The paper, written by Jesse M. Raiten, MD, assistant professor of Clinical Anesthesiology and Critical Care, and Mark D. Neuman, MD, MSc, assistant professor of Anesthesiology and Critical Care, discusses one patient’s long course of recovery in the intensive care unit after a major cardiac surgical procedure to call attention to the uncertain nature of medical decision-making for patients and physicians alike. Highlighting the growing presence in U.S. intensive care units of the “chronically critically ill”—patients whose needs for acute medical care may extend over months—Dr. Raiten and Dr. Neuman stress the difficult emotional consequences that patients and families can experience over the course of a complicated and prolonged recovery from surgery. 

According to Raiten, “our essay focuses on one specific patient who had heart surgery, but the problems that this case illustrates are relevant to any number of patients who undergo major operations in U.S. hospitals each year. And while surgery and intensive care today have incredible potential to prolong and improve patients’ lives, the regret that this individual patient expressed in looking back on her care is a tragic lesson in how far we still have to go.”

To Neuman, such patients’ experiences point to important challenges for health policy. As he notes, “most efforts to improve decision-making about surgical care focus primarily on improving physicians’ communication to their patients of the risks and benefits of a procedure. Our essay highlights the fact that physicians themselves can’t make definite predictions about an individual patient’s recovery. For physicians, acknowledging that any choice to undergo surgery involves a high degree of uncertainty represents a key first step towards improving the experiences of patients like the one we discuss.”  


Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation’s first medical school) and the University of Pennsylvania Health System, which together form a $4.3 billion enterprise.

The Perelman School of Medicine is currently ranked #2 in U.S. News & World Report’s survey of research-oriented medical schools. The School is consistently among the nation’s top recipients of funding from the National Institutes of Health, with $479.3 million awarded in the 2011 fiscal year.

The University of Pennsylvania Health System’s patient care facilities include: The Hospital of the University of Pennsylvania — recognized as one of the nation’s top “Honor Roll” hospitals by U.S. News & World Report; Penn Presbyterian Medical Center; and Pennsylvania Hospital — the nation’s first hospital, founded in 1751. Penn Medicine also includes additional patient care facilities and services throughout the Philadelphia region.

Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2011, Penn Medicine provided $854 million to benefit our community.

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