How doctor’s die

Although this Saturday Evening Post article comparing how physicians and patients prefer end of life treatment is from 2013, it is interesting throughout.

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.

Why did this renowned surgeon forego medical treatment that could have potentially extended his life?

Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen—that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).

So why don’t physicians treat patients like they would like to be treated?  Oftentimes, caregiver preferences may be to extend the patient’s life whereas patients may focus on improved quality of life.  Patients themselves may ask to “do everything” to save their life, but without a sense of what everything means.  In addition, incentives in the health care system favor more intervention.

Consider the case of a man named Jack who had documented do not resuscitate (DNR) order.  When the patient’s primary physician intervened to end the provision of life support, here is what happened.

One of the nurses, I later found out, even reported my unplugging of Jack to the authorities as a possible homicide. Nothing came of it, of course; Jack’s wishes had been spelled out explicitly, and he’d left the paperwork to prove it. But the prospect of a police investigation is terrifying for any physician. I could far more easily have left Jack on life support against his stated wishes, prolonging his life, and his suffering, a few more weeks. I would even have made a little more money, and Medicare would have ended up with an additional $500,000 bill. It’s no wonder many doctors err on the side of over-treatment.

 

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