Wednesday, January 30, 2013

Doctors Die Differently

It was this podcast, "The Bitter End"

From the awesome radio show radiolab that covered a topic that people are often reluctant to discuss but is an important part of our reality...as they say there are few things in life but birth death (and taxes) are at the top of the list.

The piece included a review from the Johns Hopkins (Study of a LifeTime) of people's desires when it comes to life saving treatments especially as it relates to end of life:

Preferences of physician-participants for treatment given a scenario of irreversible brain injury without terminal illness. Percentage of physicians shown on the vertical axis. For cardiopulmonary resuscitation (CPR), surgery, and invasive diagnostic testing, no choice for a trial of treatment was given. Data from the Johns Hopkins Precursors Study, 1998. Courtesy of Joseph Gallo, "Life-Sustaining Treatments: What Do Physicians Want and Do They Express Their Wishes to Others?"

For some simple questions such as:

  • Would you want CPR administered
  • Would you want Artifical Ventilation administered
  • Would you want Dialysis administered
  • Would you want a Feeding Tube used

Physicians were fairly uniform with 80% declining all of the above therapies. The only question that physicians were uniformly in favor of was the administration of pain medication.

But ask the same question of the general public and the numbers are reversed on every therapy (except pain management where there is agreement)

Its not that doctors don't want to die, its just that they knwo they know enough about modern medicine to know its limits, importantly they have talked about this with their families as they want to be sure that no heroic measures will be used during their last moments in this reality.

In this excellent piece: "How Doctors Die; It’s Not Like the Rest of Us, But It Should Be" Ken Murray elegantly discusses this discrepancy

The challenge is clear and effective communication on a topic that we are reluctant to take on:

It’s easy to find fault with both doctors and patients in such stories, but in many ways all the parties are simply victims of a larger system that encourages excessive treatment. In some unfortunate cases, doctors use the fee-for-service model to do everything they can, no matter how pointless, to make money. More commonly, though, doctors are fearful of litigation and do whatever they’re asked, with little feedback, to avoid getting in trouble.

My personal technique when I was practicing was to use the benchmark of my own family. Depending on the age fo the patient I would ask myself the questions:

What would I do if this was my <insert name of close family relative>

So:

What would I do if this was my son/daughter
What would I do if this was my spouse
What would I do if this was my mother/father/brother/sister
What would I do if this was my grandfather/grandmother

It may seem simple but it worked for me, and still does. The principle applies with general discussions between family members and realtives.

I knwo this seems morose and depressing but remember death is not alwasy the worst case scenario.

Posted via email from drnic's posterous