Physician, know thy limits

In their introductory article on problems for clinical judgement, Donald Redelmeier and colleagues stated that “examples of clinical judgement range from the monumental (such as whether to discontinue life-support for a patient on dialysis) to the banal (such as whether to discontinue a telephone call when on hold with nephrology).”¹ The authors' example of a situation requiring monumental clinical judgement is unclear. If a patient is competent, he or she should make the decision to stop treatment. If the patient is not competent, then family members should decide. Physicians may, of course, need to determine if life-support is in fact only prolonging the dying process. I suspect it is this decision that the authors felt requires monumental clinical judgement.

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Stephen Workman
Assistant Professor Division of General Internal Medicine Dalhousie University Halifax, NS