Kyle Karches

All articles by Kyle Karches

Determination of death

I. Problem/Challenge. As inpatient physicians, hospitalists must often declare the cardiopulmonary death of a patient. There are several different scenarios in which hospitalist physicians may find themselves: 1) an expected death of a patient with do not resuscitate (DNR) orders; 2) a sudden unexpected death; or 3) death following unsuccessful resuscitative efforts. A hospitalist should…

Assessing decision making capacity

. Physicians are not very good at determining medical decision-making capacity, even though incapacity is common. Eighteen to thirty-five percent of medicine inpatients lack capacity. On average, 44% of nursing home bound, 54% of Alzheimer’s, and 68% of learning disabled patients lack capacity. Physicians often receive no formal training in capacity determination and routinely miss…

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