To Be Full Code or Not To Be: A Physician’s Dilemma

To Be Full Code or Not To Be: A Physician’s Dilemma

[Amruti Borad, DO shares her personal journey from Full Code to DNR to Full Code status as a physician.]

Code status: Full Code.

This is a false assumption that many will make about young, healthy patients.

I certainly made this inference on many occasions throughout my medical training, often stating: “Your code status is full code, right?” rather than the open-ended: “What is your code status?”

I was Full Code, myself, and didn’t have the insight as to why someone would choose not to be, not to fight for the privilege of life.



This was until two transformative experiences during my residency.

The first involved a patient with no written power of attorney and the three children who consistently argued over the plan of care until the patient passed away.

They lashed out at every team member, with myself as the least experienced of the team, experiencing the worst of it.

I still remember the ICU attending advising that no healthcare professional should ever overlook verbal abuse, and that I had the right to report it.

But I never did.

Although, I had mixed emotions about this, ultimately I realized it was a grieving family, grasping at straws because there was no plan.


The second experience was my last shift on my ICU rotation:

3 of the patients I was taking care of with my team died, each during their own code blue, the last of which was the most traumatizing of all.

The last was most impactful because it involved a large family that had decided on full code and after the 3rd code blue on this same patient, they agreed it was enough.

I still remember breaking down into tears, being sent to the call room to finish my notes and go home. And then not having the energy or the emotional capacity to attend a funeral the following day (meaning a few hours after I got home from this shift).

This was the experience I remember most vividly from my training and THE one that prompted me to officially and legally change my code status to DNR/DNI at the age 28. There was no doubt in my mind that I would ever make a hard situation harder for my family or  settle for anything less than an excellent quality of life.


To Be Full Code or Not To Be: A Physician's Dilemma


I only momentarily doubted this decision.

This happened when I got married and my husband and I were completing our Advance Directives and he was confused and surprised by this choice.

I informed him that quality of life means everything to me, that I would want him to move on and be happy rather than taking care of a “vegetable,” and that I was not afraid of death because it is inevitable and not in my control.

I questioned this decision a second time when I found out I was having my first child, and then really started to have reservations when I considered my daughter growing up without a mother and my husband having to raise a child on his own.

I realized that I had a choice after Full Code: That if I were Full Code, and received CPR or was intubated, and then subsequently minimally disabled, I would want to be there for my daughter and teach her how to rise from adversity and treat everyone with respect.

If not, I had the ability to state my exact wishes in my Advance Directive.

It made me realize that code status is beyond black and white, that there is a grey zone and it is that grey zone where the confusion lies and why I think it is essential for medical trainees to learn how to communicate about advance directives, and why there needs to be continued education for Attending Physicians.



No matter what your specialty, this experience was a part of your training.

As a Family Physician, although it does become less jarring as I frequently participate in this dialogue, it is never easy. There is a human being and their family on the other side, and there is hardly enough time.

So, how do we better prepare for this?

Is there something else we can do early on in our medical training to approach this with compassion, non-judgement and patience in the limited time we are given?


The studies

According to a study from June 2022, republished in the American Journal of Hospice and Palliative Medicine in April 2023, forty seven medical students were enrolled in an ACP curriculum over three years. Although a small N size, the findings were statistically significant: comfortability with the discussion improved from 4% to 36%; the student’s need for attending supervision declined from 51% to 0%; and all students either agreed or strongly agreed that they felt more prepared to have this discussion with a real patient. The most beneficial was group discussions and simulated patients.

In another study from March 2019, republished in the American Journal of Hospice and Palliative Medicine in July 2019, a different approach was taken.

As is still common practice, real standardized patients were utilized, but they were an older demographic.

Two-hundred and twenty three medical students participated in these interactions after lectures and supplemental information and there was a statistically significant improvement in seven studied domains:


(1) introduce subject of EoL;

(2) define advance directives;

(3) assess values, goals, and priorities;

(4) discuss prior experience with death;

(5) assess expectations about treatment and hospitalization;

(6) explain cardiopulmonary resuscitation and outcomes; and

(7) deal with own feelings about EoL and providers’ limitations


Although both studies focused on third and fourth year medical students, I would offer that if medical education continues its traditional path (first two years didactic and last two years clinic), it may be beneficial to begin this training in the second year to make the transition to clinical practice and communication with patients smoother.

With AI technology on the rise, such simulations are likely to become easier to widely implement.

Do you have a compelling personal story you’d like to see published on SoMeDocs? Find out what we’re looking for here and submit your writing, or send us a pitch.


Earn CME

This learning experience is powered by CMEfy - a platform that brings relevant CMEs to busy clinicians, at the right place and right time. Using short learning nudges, clinicians can reflect and unlock AMA PRA Category 1 Credit.

Leave a Reply

Your email address will not be published. Required fields are marked *

Affiliate ad

Earn CME

This learning experience is powered by CMEfy - a platform that brings relevant CMEs to busy clinicians, at the right place and right time. Using short learning nudges, clinicians can reflect and unlock AMA PRA Category 1 Credit.

Tweet Me

More from SoMeDocs

Subscribe To Our Newsletter

Get updates and learn from the best

Blog: Badge of Burnout

A physician’s personal account of battling burnout and mental health struggles, with lessons learned and aspirations to live a more joyful, fulfilling life.

The True Art of Medicine

The Crafting Doctors

Doctors do some incredible work outside of the exam room. Some even craft! Take a peek at some of our highlighted doctors, here, in this series.

David Norris, MD, MBA

Negotiate as a Physician and Win

Catch this 8-part series, hosted by physician & business consultant David Norris, MD, MBA & produced by Dana Corriel, MD. Learn to be a stronger negotiator with these important tactics.

My “Go To” Spices for Indian Food: Beginner’s Guide

The Doctor’s Food

In honor of our upcoming virtual Lifestyle Medicine conference, we thought it would be fun to share some of what doctors eat (and prepare!), released regularly. Bottoms’ up!

Bryce Bowers, DO

Bryce Bowers, DO

“We must first take care of ourselves in order to take care of the patient.”

Want More?

Be a part of the healthcare revolution.
Don't miss a thing SoMeDocs publishes!

Disclaimer: SoMeDocs assumes no responsibility for the accuracy, claims, or content of the individual experts' profiles, contributions and courses. Details within posts cannot be verified. This site does not represent medical advice and you should always consult with your private physician before taking on anything you read online. See SoMeDocs' Terms of Use for more information.

follow us

© 2023 SoMeDocs. All Rights Reserved.

Support A Platform that Celebrates Real Doctors

For just $10 a month, you can help keep this openly accessible site available to all & help us sponsor in more doctors.

Interested in the must-read, unique content from our magazine?

I acknowledge that this site is not to be used for medical advice.

Play Video
Our Founder Answers Your BURNING Question


“Why should I become a member of SoMeDocs if I already have my own space online?”

Site SoMeDocs Logo, square