Mortality is a Topic for Discussion
Throughout my career, the focus has always been on the positive. How the patient will improve. Identifying what goals can be achieved. Negatives were discussed only as barriers to positive outcomes. Death is only discussed in terms of someone having died, not having the potential to die. I've heard death discussed as a possible outcome when talking about critically ill patients. It doesn't seem to come up as a topic in relation to physical therapy.
It should. I realized this last week when discussing a new admission to the rehabilitation unit. She is elderly with orthopedic injuries to both legs. She will be non-weight bearing through either leg for at least eight weeks. I was talking with another therapist about potential goals and mentioned it might not matter. The injuries could end up being fatal. Unilateral hip fractures in the elderly are associated with a 15-25 percent mortality rate in the first year and this woman injured both legs.
You could have heard a pin drop. I don't think I could have caused more shock if I started cursing. Apparently I uttered the unspeakable. There seems to be an unspoken taboo preventing discussion of mortality about physical therapy patients. You just don't say someone might die. I never said I thought the woman would die. Nor did I say she would die from her injuries. I said given her injuries, age and co-morbidities, there was chance she could die within a year.
I don't think it was wrong to say that. Before writing this blog, I found 10 articles dating from 2000 to 2010 that support my statement about hip fracture and death in the elderly. Our patients are getting sicker. The odds of someone dying after an injury or illness requiring physical therapy are increasing. That needs to be acknowledged when we're talking about our patients.
There is nothing wrong with saying someone is at a higher risk due to an injury. There is something wrong with deliberately avoiding the topic. If I know someone is high risk, I can shape a treatment plan to counteract the immobility. There's a lot to be said for positive thinking but reality can't be ignored. As professionals we need to at least acknowledge the possibility of death. We don't have to like it. It doesn't have to be lunch conversation. We just have to admit it could happen.