How Doctors Die 646
Hugh Pickens writes "Dr. Ken Murray, a Clinical Assistant Professor of Family Medicine at USC, writes that doctors don't die like the rest of us. What's unusual about doctors is not how much treatment they get when faced with death themselves, 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 because 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. 'Almost all medical professionals have seen what we call "futile care" being performed on people,' writes Murray. '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."' Feeding into the problem are unrealistic expectations of what doctors can accomplish. Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. If a patient suffers from severe illness, old age, or a terminal disease, the odds of a good outcome from CPR are infinitesimal, while the odds of suffering are overwhelming."
Re:This is what's wrong with private healthcare. (Score:4, Informative)
If the Dr. is profit motivated. This stuff usually isn't the best use. Too much expensive gear to run, patients who are mostly on Medicare getting a reduced rate for their services, then you will need to fight with the insurance companies and the documentation to try to get your money.
Specialists is where they make money. The patient comes in (often with better Insurance) you cure their particular problem, schedule a few follow ups. And get them out and you get a bunch more people in. I haven't seen any doctor (and I have worked with really stupid, mean and greedy ones) that would allow a patient to suffer just to make extra money.
For these cases it is often the family trying to extend the life of their love ones or there a request to be kept alive. If the Doctor lets them die, then they get law suits.
Food for thought (Score:5, Informative)
Over 50% of health care spending goes to pay for the last two weeks of life.
Re:This is what's wrong with private healthcare. (Score:5, Informative)
Troll?
I'm a physician that works for a hospital.
I have the futility talk with patients and their families quite frequently. It kills a little bit of me when I hear a family say they want everything done. And a little more dies every time I run a "mega code", lasting over an hour trying to save someone who if by some miracle they survive, will have no quality of life and be dependent on machines for breathing and feeding and urinating (hemodialysis) for the rest of their life.
"Where there's life, there's hope" is a common saying in the community I work in. Every time I hear that, I cry a little inside.
I have never had a hospital administrator even hint at anything that would extend suffering. If anything, the administrators like us to call the local hospice services, to free up beds for individuals who will survive.
Re:This is what's wrong with private healthcare. (Score:5, Informative)
Often the effort to extend the terminally ills life another day/week/month is written off and not paid back in full. The profit margin at that point of life is very slim. Even procedures that aren't lifesaving and are becoming more routine have slim margins. For example, there is no (ie, zip, zero, nadda) profit on total knee or hip replacements at the hospital where I work. We have to do them because of legal requirements, but insurance won't pay more than a certain amount.
Profit could be maximized much better if the vast quantities of manpower and resources dedicated to saving those already dead were instead allocated to those who will live to pay.
As a healthcare worker, it pisses me off to see people ranting about the costs/quality of the US healthcare system without knowing anything about it other than their own pocketbook.
Re:This reminds me.... (Score:5, Informative)
Of a neurologist who had a stroke, and wrote an article about it later. It was really amusing how she wrote about it. She knew what was going on, she knew the signs, hell, she was an expert. She called for help of course, but, she talked about how during it, she was having a rich internal dialog about the process... thinking of what functions were broken, how it was manifesting and how she experienced it....
You are probably thinking about Jill Bolte Taylor's "Stroke of insight". She even made a TED talk [ted.com] about it
Re:I want to die peacefully in my sleep like my Da (Score:5, Informative)
1) Not all doctors take the Hippocratic oath. I am a doctor, and while I appreciate the sentiment behind the oath, I did not swear it myself.
2) There a many different forms of the "oath". Nobody today takes the oldest know form, which of course is likely not the "original" (it is unknown if Hippocrates actually was involved in the original oath anyway). Did you know that the original oath prevents a physician from performing urological sugery, abortions, or assisted suicides? And did you know the original oath required the oath-takers to give free medical care and support to their teachers for life?
3) Medical ethics has moved way, way beyond this simplistic and confusing Oath as the end-all-be-all. Re-adopting it would be like swapping out the laws of England with sharia law, or even the ten commandments.
Bringing up "the oath" is entirely irrelevant to the discussion and is a red herring. It would also be a big step backwards to include it in physician training in the future, except as a historical curiosity.
Re:I want to die peacefully in my sleep like my Da (Score:5, Informative)
I was told that applying oxygen along with chest compressions is better than compressions alone.
However...and this is important...911 operators who are trying to coax someone into giving CPR can usually get them to do the chest compressions, but all too often when the operator tells someone to breath into the dying person's mouth, the line goes dead, as does the person. When the EMTs arrive the person who was giving CPR will have faded back into the crowd. This was from an Austin EMT instructor.
Also, a nonskilled person might take too long switching from compressions to breaths and back, during which time overall blood pressure drops. It takes a while for pumping to boost blood pressure sufficiently to move it around to the brain, so the pauses to put more air in the blood can be worse than just moving around what little air is already there.
In other words, the science is pretty clear: oxygen with compressions is better than compressions alone. However, the sociology is in debate as to whether or not bystanders can be made to do things the better way, or if the less-good-but-better-than-nothing way is more likely to be implemented.
Re:Ken Murray's blog (Score:4, Informative)
No, he's just conscious, and right.
I drink coffee maybe 5 times a year, if that. It just isn't my thing, but I know caffeine addiction from the absurd quantities of pop I used to consume. It's as strong an addiction as any other drug. One day, I tried quitting cold turkey - big mistake! I would get these killer headaches that no painkiller could beat, so instead I had to wean myself off, very gradually. I still go through a cycle in the afternoon, just a few hours after waking up, where I get very sleepy for maybe a half-hour - that's caffeine withdrawal! I'm not actually tired, it's a programmed nervous response.
Moreover, caffeine doesn't perk me up at all. I could chug a gallon of Jolt cola before bed and sleep like a log. I even tried using coffee once, to power through a 48-hour death march... didn't work! That tells me that I've been consuming so much excess caffeine since childhood, that my brain's receptors are just fried from overstimulation. A lot of people are like this, so it's just not some random conjecture to say that caffeine has negative effects.
Re:This is what's wrong with private healthcare. (Score:5, Informative)
Your uncle needed someone with medical power of attorney to be there with him. It sounds like, had he chosen to arrange that with you, you could have helped him suffer less. I say this with the hope that anyone else reading this could arrange things now, before their elderly relatives aren't capable of signing such legal documents.
My wife had medical POA with her 94-year-old grandfather when he got sick and died in 2010. She literally had to sit by his bed to be there when a random doctor would come in and try to intubate or give him something the legal paperwork he'd signed years ago said he would refuse, and she had to tell the doctor NO and wave the POA and No Heroic Measures paperwork at him. She had to do the same thing when the social workers would come by to try to plan his treatment. each new care provider would make or take a photocopy of all the paperwork. (My wife had like 40 copies made.) This took a few weeks until eventually he was transferred to hospice. Even there one of the regular care nurses was furious when they stopped all treatment. In this case, though, the hospice nurse told the regular nurse to STFU and stay out of the way while my wife watched her grandfather die.
With a medical POA and No Heroic Measures paperwork, not only would the paper exist but there would be a family member there with the legal authority to enforce it.
Re:Ken Murray's blog (Score:5, Informative)
How about one of the author's nurses turning him over to the police for obeying a patient's desires to not be put back on life support?
Actually, that isn't what he claimed. Even with just his side of the story, we know it wasn't that; a nurse fulfilled her mandatory reporting requirements because the paperwork wasn't there with him, as it normally would be. The system worked, the paperwork was checked and his wishes had been followed.
Actually it seems to be a picture of the system working, regardless of the doctor's view.
Re:Ken Murray's blog (Score:5, Informative)
What he said is based on several studies (not conducted by Mormons). Here's one, just for example: http://www.sciencedaily.com/releases/2010/06/100602211940.htm [sciencedaily.com]
The study, published online in the journal of Neuropsychopharmacology, reports that frequent coffee drinkers develop a tolerance to both the anxiety-producing effects and the stimulatory effects of caffeine. While frequent consumers may feel alerted by coffee, evidence suggests that this is actually merely the reversal of the fatiguing effects of acute caffeine withdrawal. And given the increased propensity to anxiety and raised blood pressure induced by caffeine consumption, there is no net benefit to be gained.
Caffeine is highly addictive, and you cannot simply quit without severe side effects if you drink coffee daily. My boss tried to quit once years ago, and had the worst headaches of his life.
You can quit, but you have to ease off of it, not simply stop unless you want to experience terrible pain.
Re:Ken Murray's blog (Score:4, Informative)
Then here's a better study for you: http://www.sciencedaily.com/releases/2010/06/100602211940.htm [sciencedaily.com]
Approximately half of the participants were non/low caffeine consumers and the other half were medium/high caffeine consumers. All were asked to rate their personal levels of anxiety, alertness and headache before and after being given either the caffeine or the placebo. They were also asked to carry out a series of computer tasks to test for their levels of memory, attentiveness and vigilance.
In that study, they used placebos so they didn't know whether they were consuming caffeine or not and had them perform objective tests. Conclusion: regular consumption of caffeine provided no net benefit.
Re:Regenerate? (Score:4, Informative)
1. Steven Moffat has officially declared that, when they get to the end of the 12th doctor, they will use a special esoteric procedure only professional writers know, called 'making something up'.
2. Did you never see Dr Who and the Curse of Fatal Death? That's four or five more doctors right there, so we're on #15 or so now. (My favorites among them are Rowan Atkenson and Joanna Lumley, both of which would have made great Doctors back then, but probably can't run nearly enough now.).
Re:I want to die peacefully in my sleep like my Da (Score:5, Informative)
http://www.webmd.com/heart-disease/news/20101005/chest-compression-only-cpr-saves-more-lives [webmd.com]
"There may be additional benefits to this method as well. The survival edge may occur because interrupting chest compressions --- even just for rescue breathing-- may further hamper blood flow, and it takes longer to get that blood flow back when it is time for more chest compressions, explains study researcher Bentley J. Bobrow, MD, of the Arizona Department of Health Services in Phoenix."
I'd call that a very reasonable dispute. If you have papers falsifying the hypothesis, please share the links. Otherwise, I think it is reasonable to maintain that there is a dispute over whether blood flow is more important than oxygen injection. You can achieve only both, to the satisfaction of the above hypothesis, if two people are involved (one involved in compressions, one doing the breathing on a periodic basis).
I'm not saying the doctor was right, wrong or purple, only that one of the researchers involved in the study disputes the interpretation that it is solely because of scare factor and that this makes it a significant hypothesis until disproven. It may have been disproven, and if so I'd like to see the evidence, but no amount of pointing to paramedics, St. John's Ambulance, etc, will convince me that a counter-claim by a knowledgeable person was not made and that it should not be taken seriously. Habits die hard and most paramedics were trained prior to 2010, so without actual hard medical evidence I cannot tell from modern practice whether practice is governed by the knowledge now or the knowledge of several decades ago.
Things change, things evolve, but not all practitioners change and evolve with them.
Re:Ken Murray's blog (Score:5, Informative)
Give cold-turkey an actual try sometime-- it's worth it. It's about two days of headaches (a couple of ibuprofen cover this nicely) followed by three or four days of slight drowsiness. Then you're good. And when you do get around to starting back up, it's SUPER AWESOME. I do this every few months-- usually when I find myself going for a third cup of anything caffeinated in a single day.