Playing God

Last weekend, Charleston SC was faced with the threat of a category 1 hurricane. All’s well that ends well; the city barely faced winds over 40 mph and there was little to no flooding. But during preparations, I reminded myself of a recent Radiolab podcast, “Playing God.”

The podcast recounts some of the triage decision-making that occurred during catastrophic events, including at Memorial Hospital during Hurricane Katrina and after the 2010 hurricane in Haiti. Many of the follow-up conversations after these events center on how and who should make healthcare decisions in the setting of very scarce resources. The podcast discusses harrowing situations of decisions having to be made for the “greater good.”

In the end, they conclude that triage decisions cannot rationally be made by (compassionate) humans. They argue these decisions must be “systematized” without a human element, based on facts and measures of the value of human life. They note that these triage decisions are actually an “impossible piece of human business.”

Most emergency rooms have made medical triage a mundane part of their daily routine, categorizing patients on a scale of 1-5 within minutes of arrival. And emergency medical personnel have long been accustomed to the “red, yellow, green” triage system, whereby the most urgent patients (e.g. red) are treated first, and the “walking wounded” (e.g. green) can wait for long periods of time. As simple as these triage systems are to create and understand, the discomfort comes in when having to apply them in situations of limited resources.

In the medical industry, most of us will be faced with such decision-making, even outside of major disasters; as such, I highly recommend listening to this, to gain some “comfort” with the inevitable discomfort in “Playing God.”

Danielle Scheurer

Dr. Scheurer is a clinical hospitalist and the Medical Director of Quality and Safety at the Medical University of South Carolina in Charleston, South Carolina, and is Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She also serves as the Web Editor and Physician Advisor for the Society of Hospital Medicine.

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