Premonition of death in trauma: a survey of healthcare providers.

Prognostication in western medicine has traditionally been based on objective scientific criteria, yet providers often rely on a feeling or "sense" based on experience to provide prognoses. In trauma, some providers believe that patients who express a feeling of death are more likely to die. We randomly surveyed 302 members of the Eastern Association for the Surgery of Trauma regarding patient's premonitions of death (POD). Ninety-five per cent of respondents reported encountering patients who expressed POD. Fifty per cent agreed patients expressing POD had a higher mortality rate. Fifty-seven per cent believe patient willpower affects outcome. Forty-four per cent agreed patients have an innate ability to sense their ultimate outcome after injury; 85 per cent believe patient's POD do not cause deviations from protocols. Most trauma providers have encountered patients expressing POD. Whereas most believe that a patient's willpower affects outcome, they do not believe that expressing a desire to live decreases mortality with seemingly fatal injuries. Providers who have witnessed negative POD believe these patients are more likely to die, however, they do not deviate from treatment protocols. This survey represents the first attempt to understand the magnitude of premonition of death in trauma and the need for future research.

The interface: ethical decision making, medical toxicology, and emergency medicine.

The overwhelming social and economic costs of alcohol, tobacco, and other substances of abuse are discussed, as are some of the important public health interventions appropriate for emergency physicians. This article addresses the complexity of ethical decision making when toxicologic emergencies occur in emergency medicine. The management strategies for patients with apparent intoxication are addressed with regard to decision-making capacity. The balance between confidentiality and support for an individual patient and responsibility of the physician to society is discussed. The relative importance of HIPAA is compared with an individual physician's code of ethics.