The Bitter End: what doctors want is different from the general public when facing a health crisis.

On January 15th, 2013 “Radio Lab” broadcast a program called “The Bitter End” which focused on how doctors responded to questions about the kind of care they would want at a time when they had irreversible brain disease without a terminal illness.   The program comments on a compelling contrast between what the general public wants and what doctors who know how treatment at the end of life actually works. Note the bar graph which shows that doctors do not want to have the same kind of treatment that the general public might think they wanted.

After listening to this program and looking at the graph, you may want to consider what you would want.   Or at least ask: What is it that they know that I don’t?

There is a second rich resource on the web site: it is the reader reactions which are quite variable and a few of the themes that stand out:

·        Some physicians and nurses strongly criticized references to research as biased or lacking the latest data which shows higher levels of recovery from being resuscitated.  Others disagreed and completely endorsed the program as being realistic and important.  What does the internal disagreement mean? The short answer is that “you are on your own.”   Consistency of thought about what is the best course of action doesn’t exist.

·        Comments about the use of ventilators and using drugs to paralyze the patient were also intense.  Both doctors and nurses disagreed with each other as to what the effect was on the patient.  Again, what do the differences tell you about the state of treatment?  Is it possible that nurses, who spend more time with patients have a deeper insight into the patient experience?

·        These two patterns of comments may leave you with an unsettled feeling that some rather basic procedures are viewed differently by different medical personnel.  It can make decision making more complicated.

·        There are also a number of comments by listeners who share their experiences with friends, relatives or loved ones who either recovered from very serious medical problems or died.  Uniformly, the emphasis on having “the conversation” with your doctor, medical proxy and family members as to what you want is very important. “The conversation” is a frank discussion of the realistic aspects of the future health of the person in question.  Some doctors are good at this and others find it both awkward and difficult.  The latter group will be more inclined to avoid it.

Take time to read these comments with an eye to answering the questions asked.  It may help you find your voice for your end of life choices.

What is it that you would want in a life threatening situation?  If you are young, your answers may be different than when you are old.

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