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Fri Feb 8, 2013, 07:35 AM

Doctors die differently than their patients

“Do everything you can, doctor. Do anything it takes to save him.”

These are the unfortunate pleas that too many patients and their families make when dealing with terminal illness and end-of-life decisions. While the use of advance directives helps alleviate this problem by informing doctors in advance about a patient’s end-of-life wishes, there is still an underlying belief that medicine can cure everyone, even those people with the most terrible prognoses.

But doctors die differently than their patients. They often don’t want the fancy treatment, the life-prolonging chemotherapy, or the 2-hour-long cardiac resuscitation (CPR). They know the consequences, and they just say no.

Link: http://www.philly.com/philly/blogs/fieldclinic/Doctors-die-differently-than-their-patients.html

24 replies, 3565 views

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Arrow 24 replies Author Time Post
Reply Doctors die differently than their patients (Original post)
modrepub Feb 2013 OP
newfie11 Feb 2013 #1
trotsky Feb 2013 #3
polly7 Feb 2013 #7
a2liberal Feb 2013 #2
trotsky Feb 2013 #4
eggplant Feb 2013 #5
KurtNYC Feb 2013 #10
BlueCaliDem Feb 2013 #11
sarge43 Feb 2013 #12
maddiemom Feb 2013 #14
sarge43 Feb 2013 #15
Warpy Feb 2013 #17
sarge43 Feb 2013 #18
Warpy Feb 2013 #20
NorthCarolina Feb 2013 #13
a2liberal Feb 2013 #22
cbayer Feb 2013 #19
CrawlingChaos Feb 2013 #23
Botany Feb 2013 #6
ColumbusLib Feb 2013 #8
Bibliovore Feb 2013 #9
Warpy Feb 2013 #16
Skittles Feb 2013 #21
no_hypocrisy Feb 2013 #24

Response to modrepub (Original post)

Fri Feb 8, 2013, 08:58 AM

1. Not just doctors

Many medical professionals have the same idea.

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Response to newfie11 (Reply #1)

Fri Feb 8, 2013, 09:19 AM

3. It seems the more you know about life- (and suffering-) prolonging procedures...

the less you want them.

Matches how I feel about it too.

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Response to newfie11 (Reply #1)

Fri Feb 8, 2013, 09:43 AM

7. I've had this talk with many medical professionals.

Mostly all of them have definite plans on how long to try, and when to stop. Some even agree with assisted suicide. The more you know ...

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Response to modrepub (Original post)

Fri Feb 8, 2013, 09:18 AM

2. ugh

This sort of article makes the rounds every once in a while... It's all just a not very transparent attempt at trying to convince people that it's ok for insurance to not cover all the care that it should. To make it socially acceptable or even preferred for insurance to deny potentially life-saving treatments just because the success probability is not incredibly high.

No, I'm not interested in debating it. Especially on a progressive site where I would hope people would quickly recognize the evil motive. I've done that already on more conservative-ish sites

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Response to a2liberal (Reply #2)

Fri Feb 8, 2013, 09:26 AM

4. Not wanting to debate you here, but...

do you think there are any treatments that, given the choice, you wouldn't want if you were in an end-of-life situation?

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Response to a2liberal (Reply #2)

Fri Feb 8, 2013, 09:33 AM

5. Um, no.

My wife has worked as a bereavement counselor for our community hospice for many years. It has absolutely nothing to do with insurance, and any attempt to categorize it as such is incredibly callous and unfeeling.

Traumatically extending end-of-life is a horrible, horrible process. Nobody I know looks back on it later and says "I'm so glad I was able to give nana an extra three months of excruciating, gorked-out-of-her head hell." It's not about money. It's about comfort, dignity, and basic human feeling.

I don't care whether you are interested in debating it. You are plainly wrong.

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Response to a2liberal (Reply #2)

Fri Feb 8, 2013, 10:11 AM

10. Quality of Life and end of life spiritual considerations take priority over futile

attempts to deny mortality. There is no conspiracy here, only medical professionals making VERY informed decisions about their own end of life plans.

They have the money and the insurance to pursue every medical procedure there is...and yet THEY choose not to.

Insurance is not a factor here.

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Response to a2liberal (Reply #2)

Fri Feb 8, 2013, 10:12 AM

11. OR, it could also mean we need to begin thinking about legalizing voluntary euthanasia

and having the right to die with dignity as they have the right to do in the Netherlands instead of lining Big Pharma's pockets with profits from a loved one's suffering, merely prolonging the inevitable.

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Response to a2liberal (Reply #2)

Fri Feb 8, 2013, 10:17 AM

12. You've never been through this, have you?

You've never had to watch a loved one who has the cognition and mobility of a potted plant die by inches. Knowing today is the best day s/he will have; tomorrow will be worse. Meanwhile the 'care' s/he is getting covers the basic legal requirements; it can not save their life. No probability of success.

Because they didn't have DNRs, my father, mother and brother died in this manner. If he survives me, I will not put my husband through this. If for no other reason than he had to go through this with his mother.

You don't want to debate this, understand. You probably can't honestly do so, but don't get self righteous with people who been through this hell.

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Response to sarge43 (Reply #12)

Fri Feb 8, 2013, 10:38 AM

14. Brings back the Terri Schiavo case.

What terrible exploitation of what should have been a very personal decision.

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Response to maddiemom (Reply #14)

Fri Feb 8, 2013, 10:42 AM

15. It sure does.

Second on my George Bush: How Do I Hate Thee Let Me Count The Ways List.

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Response to sarge43 (Reply #12)

Fri Feb 8, 2013, 01:14 PM

17. I was able to make my mother DNR

I didn't know it at the time, but my dad had supplied her with a lethal dose of a benzodiazepine within her reach. I know that knowing it was there helped her tremendously since she knew there was a way out if it got too hard. She died without resorting to it.

When my dad told me he was tired and wanted to go, I pulled his nurse and the rest of the team into his room and told him to tell them what he'd told me. He made himself DNR.

The hardest thing about watching my folks die was doing nothing to keep them around longer. I wanted them to live forever, but not like that.

I did find a paper they'd typed out and signed in the 60s, before advance directives were a legal possibility. It instructed me to do just what I did--nothing. It would have had no legal standing, but it was nice to find after it was all over.

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Response to Warpy (Reply #17)

Fri Feb 8, 2013, 01:24 PM

18. "I wanted them to live forever,

but not like that."

One thing the experience taught me, there are worse things than death. One of them, pointless suffering.

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Response to sarge43 (Reply #18)

Fri Feb 8, 2013, 01:30 PM

20. I know that as a nurse, too.

All I could think of with my 89 year old dad was his rib cage being crunched apart like a strawberry box with the first CPR compression. If he hadn't made himself DNR, I could see myself tripping the code team.

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Response to a2liberal (Reply #2)

Fri Feb 8, 2013, 10:18 AM

13. Yep, that's pretty much it in a nutshell.

Most Americans are conditioned to be blind to "transparent" though, so the reality is that this type of thing does generally work as intended.

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Response to NorthCarolina (Reply #13)

Sun Feb 10, 2013, 02:31 AM

22. Thank you.

It's somewhat comforting to know that at least one other person sees through it.

It's disheartening (though not surprising) though that the majority chose to take my simple statement about what these articles are designed for, and get offended as if I was somehow trying to deny them or their loved ones the right to choose their own end-of-life care. But the purpose this article (it's actually the same one that keeps getting reblogged every few months) is entirely about controlling costs. The author also writes about how great Managed Care/HMOs are (also designed to "control costs" a.k.a. kill people by denying them treatment).

While I'm not too surprised at the reaction to my post, and am glad that it's slightly better than the conservative "die quickly" response, and even better than the "moderate" response about "controlling costs", people need to realize that the purpose around creating this buzz with this article is indeed those 2 things. The crazies chime in with the "die quickly", the progressives chime in with the humanitarian aspects, and the "controlling costs" folks are the ones who actually succeed. And if you're one of them, I'm sorry, but as far as I'm concerned you're the enemy. I have no problem with someone wanting to not have care that is unlikely to succeed, but if you are trying to deny me that care in the name of "controlling costs", that is unacceptable. There is absolutely no reason that in a developed country, with all the profits built into the insurance industry, that we NEED to deny someone who wants a treatment with a 10% chance of giving them a few more months, even if it's crappy quality, that choice.

Sorry about the "preaching to the choir"... I'm just not interested in gratifying those who insult me without seeing my point with a direct conversation. Also sorry about the rambling... the shallow thinking and refusal to see what to me is obvious, that is becoming more and more common here, makes me very flustered. I feel like I have Cassandra syndrome sometimes. Thanks again for showing me that at least one person can actually think about motives and long-term effects.

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Response to a2liberal (Reply #2)

Fri Feb 8, 2013, 01:25 PM

19. Not true.

http://www.zocalopublicsquare.org/2012/07/23/doctors-really-do-die-differently/ideas/nexus/

Doctors often prolong life and over-utilize life prolonging procedures because of family pressures and fears of litigation. The decisions they make in their own cases are often entirely different than those they would make for others.

An enormous amount of our health care dollars is spent on futile care at the end of life because the system is so screwed up.

This has absolutely nothing to do with insurance and to argue that it is about that is counter-productive.

My guess is you don't want to debate it because you can't back it up.... not one single iota.

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Response to a2liberal (Reply #2)

Mon Feb 11, 2013, 04:38 AM

23. I also agree with you

I agree that variations on this article are popping up everywhere, with a definite treatment-denial agenda behind them that goes way beyond DNR orders.

I am extremely cynical about this, having been through it a number of times. With regard to my elderly family members, forget the life-saving heroics, we had to fight for just basic care - even palliative care. My mother was refused a simple 6-week course of palliative chemotherapy that had a 60% chance of relieving her pain and possibly extending her life by two years (her doctor lied to us and told us there was a 20% chance, but a hospice nurse inadvertently let the truth slip later).

What my mother did receive was a gross excess of nuclear scans, which were profitable for the hospital, and when those scans put her into kidney failure, she was refused dialysis. They (Kaiser Permanente, btw) did not want to do anything for her, except scan her into organ failure and put her in hospice.

I've been through this four times with elderly relatives and in each instance, we were pressured to refuse therapeutic treatment. Even with my 62 year old uncle who had an entirely treatable respiratory condition, we were under intense pressure to deny him life-saving intubation. We insisted, he recovered and had six more good quality years.

Everything I've experienced tells me you should worry more about your elderly loved ones receiving enough care, rather than too much.

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Response to modrepub (Original post)

Fri Feb 8, 2013, 09:35 AM

6. A good friend is an ER doctor and he told that in 80% + of the cases bringing someone back ...

... means that the person just dies in another room in the hospital later because not unless
it was a drowning or an electrocution you have an underlying organic cause of the heart failure
and "it" .... the heart ..... will give out sooner or later.

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Response to modrepub (Original post)

Fri Feb 8, 2013, 09:43 AM

8. Another view

Doctors may also be more used to the reality of death- it's a natural part of life- and thus feel less need to resort to extremes to keep their own lives going regardless of the various prices that may be paid (in a variety of ways, not just financial) to do so.

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Response to modrepub (Original post)

Fri Feb 8, 2013, 10:03 AM

9. It depends on the circumstances

My grandfather was a doctor. In his late 80s he was diagnosed with four kinds of cancer, and, correspondingly, a genetic mutation that leads to a predisposition to cancer in later life; he researched options and chose his own treatment, including a blend of chemo mild enough that he never lost his hair or threw up. It worked, and he became cancer-free.

Unfortunately, he had ruined his lungs with decades of smoking (got hooked in WWII, didn't quit until he retired), and a few months later he got pneumonia, made much worse by his emphysema. They restarted his heart the first and second times it stopped, but he stayed unconscious, and the third time my grandmother said, "Enough; no more."

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Response to modrepub (Original post)

Fri Feb 8, 2013, 12:56 PM

16. Nurses tend to be the same way

I know when my kidneys finally give out completely, I'm not doing dialysis.

I've seen fellow nurses undergo heroics, but mostly when they were young or had young kids. Otherwise, no way.

I've also seen nurses get horrible diagnoses, quit their jobs, and make the best of the time they have left without ruining it with surgery or chemo. Most of them outlived the initial predictions.

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Response to modrepub (Original post)

Sat Feb 9, 2013, 04:45 AM

21. doctors know how much suffering is driven for profit only

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Response to modrepub (Original post)

Sat Feb 16, 2013, 08:28 AM

24. Conversely, my father's a retired physician.

While he isn't necessarily "dying" (although he'll be 90 in May), he doesn't seek medical treatment. Instead, I've found that he self-medicates. I found 15+ bottles of prescriptions in his bathroom without names of prescribing physicians, some of which may or may not have side effects for interactions. I've recorded the names of all the drugs for when I've needed to bring him to the emergency room to advise the treating ER doctors. And no, it's impossible to talk to him about this phenomenon. He goes beyond being angry. He gets furious. And no, he has too much cognitive awareness for me and/or my siblings to go to court and get guardianship.

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