Abstract

MACHADO, Sara; REIS-PINA, Paulo; MOTA, Ângela  and  MARQUES, Rui. Dying in Internal Medicine Wards: The Last Hours of Life. Medicina Interna [online]. 2018, vol.25, n.4, pp.286-292. ISSN 0872-671X.  https://doi.org/10.24950/rspmi/original/90/4/2018.

Introduction:The increasing longevity and number of chronic diseases justify the number of patients with palliative needs in Internal Medicine services. The internist should be able to ensure comfort care at the end of life of the patients he is attending. The study objective was to analyze the therapy performed and complementary diagnostic tests (CDT) requested within 48 hours before death. Methods: Retrospective observational study with 100 consecutive deaths (from patients with “do not resuscitate indication”) occurring in the Internal Medicine Service for a year. Results: The length of stay was 9.4 ± 7.9 days, the age 86.5 ± 9.9 years, with no gender differences. It was found that 71.0% of patients had at least one CDT application. CDTs included blood tests (54.0%), blood cultures (17.0%), radiographs (19.0%), ultrasound scans (8.0%) or computerized axial tomography (2.0%). They were prescribed: nebulizations (76.0%), antibiotic therapy (74.0%, being 44.6% broad spectrum), low molecular weight heparin (71.0%), nonopioid analgesics (53.0%), among others. In 28.0% of cases there was no prescribed analgesia. The opioid prescription rate was 19.0%. Conclusion: There is an urgent need for a paradigm shift in the care of vulnerable patients. Medicine should not always have a healing glow, but it must always take care, respecting the cultural, clinical and ethical values of the doctor-patient relationship. The internist should in end-of-life patients improve their symptomatic control and avoid the use of inappropriate CDTs without any added benefit to the human person.

Keywords : Hospitalization; Internal Medicine; Medical Futility; Palliative Care; Patient Care Management; Terminal Care.

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