Crossing the ‘bright line’ – difficult decisions at the end of life

Abstract

Patients tell us stories about their lives, their symptoms and their interpretation of them. As physicians we try to make sense of the stories, piecing together the fragments that come our way to discern a diagnosis which we then confirm or refute by examination and investigation. Thus was Samuel Gee's life as a physician: with little in the way of diagnostic tools his ‘clinical skills’ had to be honed finely and his diagnostic nose well attuned. Perhaps we have today lost some of that clinical intuition. We seek the evidence base for all we do, failing to observe subtleties in our quest for hard science. Following Gee's esteemed lead – for he was celebrated for his clinical descriptions – I will unashamedly use doctor–patient experiences to illustrate my points, particularly around end-of-life decisions.