It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.
Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen—that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).
Almost all medical professionals have seen too much of what we call “futile care” being performed on people. That’s when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, “Promise me if you find me like this that you’ll kill me.” They mean it. Some medical personnel wear medallions stamped “NO CODE” to tell physicians not to perform CPR on them. I have even seen it as a tattoo.
http://www.saturdayeveningpost.com/2013/03/06/in-the-magazine/health-in-the-magazine/how-doctors-die.html
Most physicians would choose a do-not-resuscitate or “no code” status for themselves when they are terminally ill, yet they tend to pursue aggressive, life-prolonging treatment for patients facing the same prognosis, according to a study from the Stanford University School of Medicine…
ReplyDelete“Why do we physicians choose to pursue such aggressive treatment for our patients when we wouldn’t choose it for ourselves?” said Periyakoil, director of the Stanford Palliative Care Education and Training Program. “The reasons likely are multifaceted and complex.”…
A survey shows that physician attitudes toward advance directives haven't changed much since the passage of a 1990 law giving patients more control over their end-of-life care decisions.
The lack of change in physicians’ attitudes toward advance directives mirrors what the study describes as the medical system’s continued focus on aggressive treatment at the end of life, despite the fact that most Americans now say they would prefer to die at home without life-prolonging interventions.
“A big disparity exists between what Americans say they want at the end of life and the care they actually receive,” the study said. “More than 80 percent of patients say that they wish to avoid hospitalizations and high-intensity care at the end of life, but their wishes are often overridden.”
In fact, the type of treatments they receive depends not on the patients’ care preferences or on their advance directives, but rather on the local health-care system variables, such as institutional capacity and individual doctors’ practice style, according to the study.
“Patients’ voices are often too feeble and drowned out by the speed and intensity of a fragmented health-care system,” Periyakoil said…
An overwhelming percentage of the 2013 doctors surveyed — 88.3 percent — said they would choose “no-code” or do-not-resuscitate orders for themselves...
“Our current default is ‘doing,’ but in any serious illness there comes a tipping point where the high-intensity treatment becomes more of a burden than the disease itself,” said Periyakoil, who trains physicians in palliative medicine. “It’s tricky, but physicians don’t have to figure it out by themselves. They can talk to the patients and their families and to the other interdisciplinary team members, and it becomes much easier…
“But we don’t train doctors to talk or reward them for talking. We train them to do and reward them for doing. The system needs to be changed.”
See: http://med.stanford.edu/news/all-news/2014/05/most-physicians-would-forgo-aggressive-treatment-for-themselves-.html
Do Unto Others: Doctors' Personal End-of-Life Resuscitation Preferences and Their Attitudes toward Advance DirectivesPLOS ONE Periyakoil, V. S., Neri, E., Fong, A., Kraemer, H.2014; 9 (5)
It was about 10 years ago, after a colleague had died swiftly and peacefully, that Dr. Ken Murray first noticed doctors die differently than the rest of us.
ReplyDelete"He had died at home, and it occurred to me that I couldn't remember any of our colleagues who had actually died in the hospital," Murray says. "That struck me as quite odd, because I know that most people do die in hospitals."
Murray began talking about it with other doctors.
"And I said, 'Have you noticed this phenomenon?' They thought about it, and they said, 'You know? You're right.' "
In 2011, Murray, a retired family practice physician in Los Angeles, shared his observations in an article that quickly went viral. The essay, "How Doctors Die," told the world that doctors are more likely to die at home with less aggressive care than most people get at the end of their lives. That's Murray's plan, too.
"I fit with the vast majority that want to have a gentle death, and don't want extraordinary measures taken when they have no meaning," Murray says...
Goldman read Murray's essay as part of his residency. Goldman too would prefer to die without heroic measures, he says, and knowing how doctors die is important information for patients.
"If they know that this is what we'd want for ourselves and for our own families, that goes a long way," he says.
http://www.cnn.com/2015/08/10/health/how-doctors-want-to-die/index.html