Why physicians die differently

Accessed April 25, Why doctors die differently. Wall Street Journal. February 25, Accessed April 20 , Life-sustaining treatments: what do physicians want and do they express their wishes to others? J Am Geriatr Soc. Physical functioning, depression, and preferences for treatment at the end of life: the Johns Hopkins Precursors Study. Stability of preferences for end-of-life treatment after 3 years of follow-up: the Johns Hopkins Precursors Study. Arch Intern Med.

Doctors Die Differently: Why-and How. Kate Adams, a GP in Hackney, London, thinks general practitioners "lose" their patients when they enter hospital and take end-of-life treatment decisions with consultants. Sometimes patients and distressed relatives focus on quantity," she says.

That's why it's so difficult when you see an elderly patient with cancer; their natural instinct is to go for treatment, and you must respect that — but at the same time, you're thinking, 'So now you're going to have an operation with a six-month recovery period, which might make the last three years of your life even more hellish than if you'd let the illness take its course.

How to die: 'doctors see things differently to most people'. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. 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.

But they go gently. 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. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist. I have even seen it as a tattoo.

To administer medical care that makes people suffer is anguishing. The simple, or not-so-simple, answer is this: patients, doctors, and the system. To see how patients play a role, imagine a scenario in which someone has lost consciousness and been admitted to an emergency room. As is so often the case, no one has made a plan for this situation, and shocked and scared family members find themselves caught up in a maze of choices.

Then the nightmare begins. The above scenario is a common one. 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. Poor knowledge and misguided expectations lead to a lot of bad decisions. Doctors play an enabling role, too. The trouble is that even doctors who hate to administer futile care must find a way to address the wishes of patients and families.

Imagine, once again, the emergency room with those grieving, possibly hysterical, family members. They do not know the doctor. Establishing trust and confidence under such circumstances is a very delicate thing.

People are prepared to think the doctor is acting out of base motives, trying to save time, or money, or effort, especially if the doctor is advising against further treatment.

Some doctors are stronger communicators than others, and some doctors are more adamant, but the pressures they all face are similar. When I faced circumstances involving end-of-life choices, I adopted the approach of laying out only the options that I thought were reasonable as I would in any situation as early in the process as possible. If patients or families still insisted on treatments I considered pointless or harmful, I would offer to transfer their care to another doctor or hospital.

Should I have been more forceful at times? I know that some of those transfers still haunt me.