Need advice from MDs: How often does LIFE vs DEATH come up?

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Hello. I am currently a junior majoring in Communication Sciences and Disorders, in addition to Linguistics, and I have recently considered going into medicine. Initially I was set on Speech Language Pathology, but I would prefer something that is more scientifically rigorous and quantitative. I am bored with my Speech classes because I am told the disorders and what is "normal", but am not taught the biological/neurological reason behind it. Then I was set on Audiology because I love the diagnostic and critical thinking part of, and the grad classes go very much in depth.

But recently I have been considering going MD. While I have a lot of Speech/Audiology observation experience, I have limited physician observation experience.

I love learning. I love school. I love helping people. But I am an anxious person and the thought of making a single mistake and possibly killing someone is super scary. I know that probably depends on the type of doctor you are, but I would like some perspective.

all the time... Wrote 20 death summaries in the past two months. It just is what it is.

I guess what I really am asking is if when a death occurs, doctors feel that they are to blame. Does medical school prepare students for the death of patients?

The life and death thing in medicine isn't as dramatic as TV makes it seem.

Originally Posted by greeneryforests

I guess what I really am asking is if when a death occurs, doctors feel that they are to blame. Does medical school prepare students for the death of patients?

You can desensitize to almost anything with enough repetition.

Well due to my current area of study, I am interested in pediatrics, ent, and neurology.

Originally Posted by Shnurek

You can desensitize to almost anything with enough repetition.

Very true.

To give a more helpful answer to the OP, this quote pretty well sums up the main point. Yes, medical school prepares you to deal with patient deaths, because you will see plenty of patients die during your 3rd and 4th years. You will see horrible, undignified deaths by ICU, you will see deaths with excellent advanced planning, and you will see patients who die unexpectedly. You will participate in end of life counseling with patients and families. You will be present when families are informed of deaths. You are around death all the time in the hospital.

I'm not a doctor yet, so I can't speak for how I will react to the first patient of mine who dies on me as a physician. I will never forget the first patient that was truly mine who died in my care. It was on the ambulance, and it was a perfect storm of circumstances. A guy was shot 5 times in the back in front of a police station. The police secured the scene immediately, and I just happened to be driving by in the ambulance. We were on scene within a couple minutes of him being shot, and he was still alert when I got there. We were only five minutes from the hospital, but he lost pulses en route to the ED and was dead on arrival. It's a little weird being a 22 year old kid in charge of a patient and watching him die in front of you. I had seen dead people before, but I hadn't seen death. I wasn't prepared for that. I think about him all the time.

The thing is, most of the times we deal with death in the hospital are expected. You know the guy with uncontrolled diabetes and severe CHF who is in the ICU for fulminant sepsis is probably going to die. You know the patient with terminal cancer is going to die. Even in the trauma bay, even though you don't know the patient, you know somebody is going to come in with severe trauma and not make it.

Very rare is the patient who is "single mistake" from death, even in the emergency department. They happen, though, and sooner or later I'll have to deal with it. Intern year is fast approaching, and the truth is I don't know how I'm going to react when a patient who is really mine dies. But even then, that's why we have residency training after medical school - you still have backup. The progression of responsibility is such that you really are prepared to be on your own when you finish training (so I'm told). Like I said, I don't know how I'll react as an intern, but I feel a lot more prepared than I was for my first death. Medical school does a really good job of teaching you to be a doctor.



Take that with a grain of salt. I'm an MS4, not a doctor.

Originally Posted by greeneryforests

I guess what I really am asking is if when a death occurs, doctors feel that they are to blame. Does medical school prepare students for the death of patients?

Not always. If you understand the inherent limitations of the care you provide, then you shouldn't feel the need to shoulder the burden of blame if a patient doesn't get better.

Remember, the patient is in the hospital or in your office typically because something is wrong. It's their disease process that is killing them not what you are doing. You should do your best to help rid the patient of the disease if possible. If a patient dies because their cancer spread, you are not to blame. If a patient dies from a pneumothorax you caused while placing a central line that was necessary to treat their sepsis, you are not to blame for their death. Its the disease process you are trying to help.

In my line of work, OB/GYN, we make life and death decisions every day on labor and delivery. C-sections save tons of lives.

As a doctor, I certainly feel for patients and family members with poor outcomes or when someone dies. It is REALLY HARD to tell a patient/family that nothing more can be done, or that their loved one died. While I may have "learned" how to approach people with this news, it can be very emotionally draining and it is never easy. And you never know what kind of reaction you will get.

I've had some patients that I have been upset about, and others that didn't really affect me much. But you know you have to move on and continue caring for other patients.

As far as "blaming" myself, it--for me--is more a reflection on whether there is anything I could have done differently that could have changed the outcome. I think it's fairly healthy to do this. And rarely would anything have made a difference, because whatever got the patient to that point is generally not caused by one thing, but a series of events. Most patients do not just die suddenly and unexplained. The ones that do can be unsettling, but these are a minority (exception of trauma/ER, perhaps). Most patients who die have been chronically ill, are elderly with numerous comorbidities, or came into the hospital with a problem that continues to worsen throughout their stay despite doing everything within reason to treat it.

Originally Posted by greeneryforests

Hello. I am currently a junior majoring in Communication Sciences and Disorders, in addition to Linguistics, and I have recently considered going into medicine. Initially I was set on Speech Language Pathology, but I would prefer something that is more scientifically rigorous and quantitative. I am bored with my Speech classes because I am told the disorders and what is "normal", but am not taught the biological/neurological reason behind it. Then I was set on Audiology because I love the diagnostic and critical thinking part of, and the grad classes go very much in depth.

But recently I have been considering going MD. While I have a lot of Speech/Audiology observation experience, I have limited physician observation experience.

I love learning. I love school. I love helping people. But I am an anxious person and the thought of making a single mistake and possibly killing someone is super scary. I know that probably depends on the type of doctor you are, but I would like some perspective.

You can kill a patient with every prescription you write, and most procedures you do. Particularly frail elderly or immunocompromised ICU patient types. A lot of times the odds of a patient who dies weren't that good to start with. The number of mistakes made that are truly errors of skill or judgement are actually quite low, and hopefully decrease dramatically the further along in your training you get. However, the known risks of any procedure or medication aren't insignificant, even if no one us to blame, so your goal is often to communicate the risks and do your best to manage the foreseeable complications which ultimately lead to the patients death, and then break the bad news. You learn to break bad news as an intern, not through teaching, but because it's your role.

I would caution you that if your goal is something "scientifically rigorous", then become a scientist, not a doctor. Doctors are first and foremost clinicians, and have a lot more in common in terms of their day to day work with audiologists than biochemists.

Surgeons tend to become numb to death, or compartmentalize and limit its effect on daily practice. It can be hard seeing a young, healthy patient undergo an elective procedure and end up permanently disabled or dead. No matter how thorough the statistical presentation of risk or morbid the details of complications the informed consent is never enough to prepare a patient or family for an undesirable (albeit sometimes acceptable with respect to the procedure) outcome.

Originally Posted by greatnt249

Not always. If you understand the inherent limitations of the care you provide, then you shouldn't feel the need to shoulder the burden of blame if a patient doesn't get better.

Exactly right. It can be a sad experience to see a patient go, but unless I made some mistake I would not feel guilty about it.

During the second hour of our very first lecture, our very first day of classes, the professor (an oncologist) got a call that his patient had died.

We were all like, $@&% just got REAL.

He ended up talking about the idea that as an oncologist at a tertiary care medical center, he gets all the most serious cancer cases and he never really permanently cures anybody. He helps them decide what therapies they want to do, sometimes extends their lives, but often just takes care of them as they die.

Everyone dies eventually, often a physician just helps life extend a little bit or just makes the quality a little better in the middle. Mostly it's about the trying to the best of your ability.

Anesthesiologists bring very sick people to near death and back as a matter of routine. I take the deaths that occur on the operating table to heart. They are typically traumas who were already on the verge of death. I remember each of them. I don't want to forget them. I have learned from each of those cases. But when that case is over and the next trauma is rolling in, I shut away any emotion I had and move on.

I think your prior mental, family, and spiritual life are what prepare you for deaths.