How Doctors Die is Different. What’s going on here?

A short report on California Public Radio  reviews the work of Ken Murray, MD who noticed several years ago that when his physician colleagues died, they rarely died in a hospital. He hypothesized that they had made a choice to die at home because they had seen too much unnecessary and futile aggressive treatment given to patients most likely to die.

Unfortunately, many doctors are not willing or able to talk about dying. According to some studies, only about 10% of doctors nationwide have had conversations with their patients about death and dying which means that many patients may not be told the truth about their illness.

To support this asserted communication failure, the NPR reporter who produced this piece interviewed a woman whose husband died of an inoperable brain tumor. She felt that the doctors pressed her to undertake treatments that adversely impacted the quality of his life and may also have shortened his life.

In another article, Dr. Murray shares the story of an orthopedic surgeon who consulted a colleague who diagnosed him with pancreatic cancer. Despite the fact that this physician was an expert in treating pancreatic cancer,  the survival rate was less than 15%.  Given the odds, the orthopedic surgeon closed his practice that very day and died 9 months later having spent his remaining time with his family.

Dan Gorenstein also reported on this topic on NPR’s “Market Place” commenting on the extraordinary cost of aggressive care when an older person is fighting a serious illness.  About 20% of all Medicare costs are spent in the last six months of life at the cost of roughly $300 billion dollars.

The most compelling and thorough presentation on this topic is a 20 minute Radio Lab pod cast entitled, “The Bitter End”.  Sean Cole interviewed doctors at John Hopkins regarding the results of a study of physicians’ attitudes towards treatment options if they are in a coma. A graph showed that 60%-90% elected not to have any treatment for most options (90% rejected CPR). However, more than 80% would want medicine for pain management.

Listen to the interview to hear how doctors feel about extraordinary treatment and how strongly some of them express their wishes. Note the description about what being on a ventilator is like and take note of the comment by a doctor who says to a colleague while they are working on a very sick person in the ICU, “If this happens to me, kill me.” It is also fascinating to hear Cole interview his own father (a doctor) who makes his advanced directive known.

WHAT IS THE “TAKE AWAY” FROM THIS POST?
• Doctors are less likely to elect aggressive treatment when they are faced with a serious or fatal medical problem.
• Doctors know more about the consequences both of certain illnesses and of the likely treatments.
• Doctors may not share information about the impact of treatment on the quality of life. They may be more likely  to recommend treatment different from what they would choose for themselves. You may have to push hard for this information.
• Aggressive treatment and intrusive procedures may complicate your life, degrade the quality of your time during or after the treatment.
• Aggressive treatment may permanently impact your quality of life, and/or cause your life to end sooner than with hospice and palliative care.
• Ask your doctor(s), “If you were facing my illness, what treatment would you elect to have?” Or, “If this was your mother (dad, wife, relative), what would recommend?”
• You must be alert to evaluate both the meaning and value of treatments as well as the consequences for quality of life.
NOW is the time to have serious conversations about your own mortality as well as those you love, not when you are in the ER and in the midst of confronting a serious and possibly life threatening issue.

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