How Doctors Die (article)

[daymann]

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http://www.zocalopublicsquare.org/2011/11/30/how-doctors-die/ideas/nexus/

Somewhat old article (saw this also on Allo forums but not pre-Allo), but nonetheless relevant for all you future docs. Not only do the ideas raise questions about our healthcare system/our future roles as physicians, it was spoke to me on a personal level too. It made me realize how physicianhood will bring about some fundamental shifts in my perspective on life, death and patient care. Scary stuff.. Discuss!

 

[jw23]

Word. Powerful read.

 

[ilikevegetables]

word. Powerful read.

+1

 

[JBOB]

Good article. It's interesting to compare this one to all the articles which are floating around about the California nurse who refused to perform CPR on an 87 year old nursing home resident.

 

[mehc012]

Good article. It's interesting to compare this one to all the articles which are floating around about the California nurse who refused to perform CPR on an 87 year old nursing home resident.

You mean the woman who did her job and followed her facility's policies?

 

[JBOB]

You mean the woman who did her job and followed her facility's policies?

That is exactly right, but that's not how it's being portrayed at all in the media.

 

[sinombre]

You mean the woman who did her job and followed her facility's policies?

I haven't read this article, so I don't have an opinion on it, but... I think whether or not she followed her facility's policies is kind of irrelevant.

Also, thanks for posting OP.

 

[SpaceyWacey]

http://www.zocalopublicsquare.org/2011/11/30/how-doctors-die/ideas/nexus/

Somewhat old article (saw this also on Allo forums but not pre-Allo), but nonetheless relevant for all you future docs. Not only do the ideas raise questions about our healthcare system/our future roles as physicians, it was spoke to me on a personal level too. It made me realize how physicianhood will bring about some fundamental shifts in my perspective on life, death and patient care. Scary stuff.. Discuss!

Pretty scary, but it only because it makes you really think about what you want in your life. If anything were ever to happen to me or someone within my family, even though it would be hard, I would hope that we would be able to think reasonably.

 

[WompyWomperton]

Good article. It's interesting to compare this one to all the articles which are floating around about the California nurse who refused to perform CPR on an 87 year old nursing home resident.

My thoughts exactly. I was a little shocked at how that blew up seeing as how the woman was 87 years old. Proper CPR on a brittle 87 year old would be horrible.

 

[Faol]

My thoughts exactly. I was a little shocked at how that blew up seeing as how the woman was 87 years old. Proper CPR on a brittle 87 year old would be horrible.

The complaint was that she refused to hand the phone to someone who was qualified to perform medical care.

"'The California Board of Registered Nursing is concerned that the woman who spoke to the 911 dispatcher did not even respond to requests to find someone who might want to help.

'If she's not engaged in the practice of nursing, there's no obligation (to help),' agency spokesman Russ Heimerich said. 'What complicates this further is the idea that she wouldn't hand the phone over either. So that's why we want to look into it."'

Source:http://hosted.ap.org/dynamic/storie...ME&TEMPLATE=DEFAULT&CTIME=2013-03-06-11-49-32

 

[silverturtle]

Word. Powerful read.

Same exact sentiment 👍

 

[Narmerguy]

Wow that was good stuff. The comments are (refreshingly) great as well.

I don't think we need to make this a thread about that nurse, though someone feel free to make a separate thread for that as I'm sure many people have thoughts. Each topic deserves its own thread (isn't this the stuff that's nice to see around the forum? 😛)

 

[Geebeejay]

I'm only a CNA so far, and I already have adopted this mindset! Once I hit, I dunno, 50 or 60, I am definitely going to be getting DNR tattooed on my chest right over my sternum.

Nice to see a strong physician consensus away from "cutting edge" treatments for themselves that prolong life minimally and degrade quality of life greatly.

 

[mehc012]

I haven't read this article, so I don't have an opinion on it, but... I think whether or not she followed her facility's policies is kind of irrelevant.

Also, thanks for posting OP.

Narmerguy's right, so I SWEAR TO ALL THAT IS SACRED TO SDN (the 45T?) this is the only thing I'll say on the matter:

It's only not irrelevant because the facility had a clear policy, which all residents and residents' families should have been aware of before agreeing to live there, that CPR would not be performed by the facility staff, ever. Agreeing to live there with those terms was essentially agreeing not to have CPR performed in case of cardiac arrest.

 

[sinombre]

Last response as well.

Narmerguy's right, so I SWEAR TO ALL THAT IS SACRED TO SDN (the 45T?) this is the only thing I'll say on the matter:

lol

It's only not irrelevant because the facility had a clear policy, which all residents and residents' families should have been aware of before agreeing to live there, that CPR would not be performed by the facility staff, ever. Agreeing to live there with those terms was essentially agreeing not to have CPR performed in case of cardiac arrest.

Gotcha. Maybe someone should start a thread on this...

 

[BABSstudent]

http://www.zocalopublicsquare.org/2011/11/30/how-doctors-die/ideas/nexus/

Somewhat old article (saw this also on Allo forums but not pre-Allo), but nonetheless relevant for all you future docs. Not only do the ideas raise questions about our healthcare system/our future roles as physicians, it was spoke to me on a personal level too. It made me realize how physicianhood will bring about some fundamental shifts in my perspective on life, death and patient care. Scary stuff.. Discuss!

This is one of the reasons why I am glad Washington has physician assisted suicide. If I become terminally ill, I want to focus on enjoying my time until the pain becomes too great or I pass away.

 

[UTKpreMD]

Great article... The comments are good too:

"why are coffin lids nailed down?

So oncologists will stop chemo"

heh that sounds about right...

 

[Panamaniac17]

"If there is a state of the art of end-of-life care, it is this: death with dignity"

I will remember that statement as I head into this career

 

[mehc012]

Great article... The comments are good too:

"why are coffin lids nailed down?

So oncologists will stop chemo"

heh that sounds about right...

Haha, yeah, that one was good.

 

[Lamel]

Great read.

 

[Renae]

Narmerguy's right, so I SWEAR TO ALL THAT IS SACRED TO SDN (the 45T?) QUOTE]

lol

 

[jeffs office]

Thanks for sharing.

 

[The Beyonder]

I'm only a CNA so far, and I already have adopted this mindset! Once I hit, I dunno, 50 or 60, I am definitely going to be getting DNR tattooed on my chest right over my sternum.

Nice to see a strong physician consensus away from "cutting edge" treatments for themselves that prolong life minimally and degrade quality of life greatly.

I agree with the DNR. It's so odd that physicians are providing care they would not want themselves.

 

[amazing tekkers]

That was a good read.

 

[The Beyonder]

Wow that was good stuff. The comments are (refreshingly) great as well.

I don't think we need to make this a thread about that nurse, though someone feel free to make a separate thread for that as I'm sure many people have thoughts. Each topic deserves its own thread (isn't this the stuff that's nice to see around the forum? 😛)

There is already a thread.

http://forums.studentdoctor.net/showthread.php?t=988768

 

[Geebeejay]

I agree with the DNR. It's so odd that physicians are providing care they would not want themselves.

Well, that's the thing with "Patient and family centered care" that hospitals are embracing. Doctors can have opinions and can be as persuasive as they want within ethical reason, but the whole point of "informed consent" is that the patient (or the family if the patient is incompetent) ultimately decides to treat or not treat, and which treatment to use.

Obviously, laypeople do not have as much exposure to the true quality of life of patients with certain diseases on certain treatment plans, as well as those ".5%" complications that are really horrible that may make doctors think otherwise when presented with the same treatment options.

 

[dsoz]

Ever since I watched my father pass away from a brain tumor, I knew that I would not want those forms of "life saving" techniques performed on me.

Then watching my mother die of alcohol induced cirrhosis of the liver leading to total organ failure sealed the deal.

My dad was a very lively guy. Valedictorian of his high school, and an electrical engineer. Crossword and jumble completed every day before he finished breakfast and went off to work. The brain tumor required removing the front quarter of the left side of his brain. He was never the same. He could walk and talk again 6 months later, but he was reduced to watching "Everyone Loves Raymond" reruns instead of his usual puzzles. He was not the same. That is not something I would want to choose for myself. I would rather have a month of normal, followed by a quick end than have a year of decreased capability and a second year of lingering agony.

I agree with an above poster. If I ever decide to get a tattoo, the only thing I would get would be DNR over my chest in LARGE letters. My wife does not agree, but my kids know, and maybe they can talk sense into her if/when the time comes.

Maybe it is time to bring home one of those advance directive packets from the hospital and fill it out.

dsoz

 

[Geebeejay]

Ever since I watched my father pass away from a brain tumor, I knew that I would not want those forms of "life saving" techniques performed on me.

Then watching my mother die of alcohol induced cirrhosis of the liver leading to total organ failure sealed the deal.

My dad was a very lively guy. Valedictorian of his high school, and an electrical engineer. Crossword and jumble completed every day before he finished breakfast and went off to work. The brain tumor required removing the front quarter of the left side of his brain. He was never the same. He could walk and talk again 6 months later, but he was reduced to watching "Everyone Loves Raymond" reruns instead of his usual puzzles. He was not the same. That is not something I would want to choose for myself. I would rather have a month of normal, followed by a quick end than have a year of decreased capability and a second year of lingering agony.

I agree with an above poster. If I ever decide to get a tattoo, the only thing I would get would be DNR over my chest in LARGE letters. My wife does not agree, but my kids know, and maybe they can talk sense into her if/when the time comes.

Maybe it is time to bring home one of those advance directive packets from the hospital and fill it out.

dsoz

Whoa whoa, don't get me wrong by my post, CPR can miraculously save young people. You don't want to be 40, have an MI, code in the cath lab and then not be resuscitated when you have a pretty good chance of fully recovering, or pretty close to it! Throw a pacemaker in me, and I might have 30+ more years left! I had a patient once who coded in the ED, was successfully resuscitated three times (came up swinging and yelling each time before we finally intubated him), was cathed, extubated, and went home before the end of the week. He was 50 I think.

I'm all about DNR, but as long as I'm young and healthy, pound away on my chest. I think it's also important to have family members that know exactly what you want and don't want in certain situations.

 

[futureczar]

Definitely no crazy life saving measures for me. Just let me die dammit!

Althought comparing someone dying from cancer is very different than comparing a 20 year old who got into a tragic accident. I think having a DNR in your later years is very reasonable, but if I get into a car accident tommorow I want that CPR!

 

[BABSstudent]

Definitely no crazy life saving measures for me. Just let me die dammit!

Althought comparing someone dying from cancer is very different than comparing a 20 year old who got into a tragic accident. I think having a DNR in your later years is very reasonable, but if I get into a car accident tommorow I want that CPR!

I actually just talked about this to my fiancée. After about 60 I want a DNR. Before then I want to be brought back to life by all means.

 

[mimelim]

I agree with an above poster. If I ever decide to get a tattoo, the only thing I would get would be DNR over my chest in LARGE letters. My wife does not agree, but my kids know, and maybe they can talk sense into her if/when the time comes.

Maybe it is time to bring home one of those advance directive packets from the hospital and fill it out.

dsoz

I brought someone back from the dead two days ago, which would be entirely impossible if they had done what you are saying. There is a time and a place for CPR and modern medicine in general. The point is that just because you can get a pulse back doesn't mean that you always should. Going to the other extreme is equally bad. I am 27 years old and my wife and I have explicit advanced directives for end of life decisions.

 

[tyrionlannister]

DNRs are overrated for their effectiveness, weight, and appropriateness. They can be helpful in a sticky situation, but the best thing you can do by far is have the conversation with anyone that might be a decision-maker on your behalf. This can save your life and/or save your loved ones lots of misery.

Also, make sure you and they are at peace with your decisions. A moment of hesitation can begin a treatment course that is hard to stop once begun. Doesn't matter who you are, there is an element of fear when you come to terms with your own expiration date. Most patients I've worked with have said at some point, "Don't do that to me when it's my time." Most patients ask us to do it to them when it's their time, and this includes former doctors and nurses who "know what to expect,"

Finally, anyone who changes their treatment course based on a tattoo should have their license revoked.

 

[BABSstudent]

Finally, anyone who changes their treatment course based on a tattoo should have their license revoked.

How does it change with a necklace, piece of paper in a wallet, something saved on their phone, something said to a loved one, etc.

I think a tattoo that says "no code" or "do not resuscitate" is proof that the person doesn't want to be saved. I mean, they got a freakin tattoo of it! Those don't take 30 seconds to get. The person sat through hours of having a needle repeatedly jabbed into them to make the message clear and you want to ignore it? What else do they need to do?!?!?!?!?!?

 

[pre med 2014]

Hmmm, making a generalization about all doctors based on one example. Highly scientific.

 

[mehc012]

Hmmm, making a generalization about all doctors based on one example. Highly scientific.

Yeah, a few stats would be nice...but then again, it's not a great area for gathering statistics. Sure, you might find that more docs than not have DNRs or conservative advanced directives (conservative here meaning less extreme measures to be taken)...but there's not a great sample of non-docs to compare them to, as the proportion of healthcare workers with ANY advance directives is probably higher than the proportion of general population with them (and those of the general population who do have them likely do so because of advanced age, impending med issues, or some other trigger).

 

[tyrionlannister]

How does it change with a necklace, piece of paper in a wallet, something saved on their phone, something said to a loved one, etc.

I think a tattoo that says "no code" or "do not resuscitate" is proof that the person doesn't want to be saved... What else do they need to do?!?!?!?!?!?

A bracelet or necklace can be part of an institution's system for identifying specific types of advanced directive patients (e.g. "No code" necklace for those that don't want CPR, or a colored sticker on a chart). But if you see a patient you don't know in a place where that is not the system, how do you know that they didn't get that bracelet as a gift from a relative that hates to watch them suffer (saw this with an Alzheimer's patient)? For a tattoo, people regret them all the time. How easy would it be to get one of those after watching a loved one die in a bad way on life support, but weeks later be in an accident where chances of revival and normal life are great? The right thing to do in that situation would be to resuscitate the patient.

A tattoo or necklace can cause people to look for an advanced directive or postpone the ventilator for a bit longer. But, you cannot withhold life saving measures based on that alone.

 

[BABSstudent]

A bracelet or necklace can be part of an institution's system for identifying specific types of advanced directive patients (e.g. "No code" necklace for those that don't want CPR, or a colored sticker on a chart). But if you see a patient you don't know in a place where that is not the system, how do you know that they didn't get that bracelet as a gift from a relative that hates to watch them suffer (saw this with an Alzheimer's patient)? For a tattoo, people regret them all the time. How easy would it be to get one of those after watching a loved one die in a bad way on life support, but weeks later be in an accident where chances of revival and normal life are great? The right thing to do in that situation would be to resuscitate the patient.

A tattoo or necklace can cause people to look for an advanced directive or postpone the ventilator for a bit longer. But, you cannot withhold life saving measures based on that alone.

What if a "loved one" is present to say do not resuscitate but is actually the someone who hates the patient? Do you ignore them and just resuscitate? How would you know their true intentions?

My grandparents are Jehovah Witnesses and have bracelets that state they refuse all medical treatment because they believe they will go to hell if they receive certain kinds of aid. They didn't buy the bracelets from a certain hospital. I thought it was universal understanding. Would you stop if you saw it or would you save a life and have them regret it for their entire life because they think they will burn for eternity?

Personally, if I saw any sign that the patient made an effort to refuse life saving treatment while in a sane state of mind then I would honor their wishes. Whether that was to save them or to let then be.

 

[tyrionlannister]

What if a "loved one" is present to say do not resuscitate but is actually the someone who hates the patient?

Personally, if I saw any sign that the patient made an effort to refuse life saving treatment while in a sane state of mind then I would honor their wishes. Whether that was to save them or to let then be.

If the person making decisions on your behalf is your secret sworn enemy (or your overt one, for that matter), then it sucks to be you. That's why you should have these discussions and choose your medical power of attorney before you need them. Often, the people that end up making decisions for us do not do it how we'd want.

For the bracelet part, it's a lot easier to express "Refuse all medical treatment" than it is to express, "Don't give me compressions, but please use oxygen or an ambubag. And shock me if my heart stops due to a mistake in medication dosage or a myocardial infarction, but don't shock me if my heart stops for neurogenic reasons. Also, go ahead and give me my nitroglycerin treatment in any case."

Do what you have support to believe in regarding your patients' wishes. If you refuse all treatment based on a DNR tattoo, you may be murdering a respected member of the Department of Natural Resources.

 

[BABSstudent]

If the person making decisions on your behalf is your secret sworn enemy (or your overt one, for that matter), then it sucks to be you. That's why you should have these discussions and choose your medical power of attorney before you need them. Often, the people that end up making decisions for us do not do it how we'd want.

For the bracelet part, it's a lot easier to express "Refuse all medical treatment" than it is to express, "Don't give me compressions, but please use oxygen or an ambubag. And shock me if my heart stops due to a mistake in medication dosage or a myocardial infarction, but don't shock me if my heart stops for neurogenic reasons. Also, go ahead and give me my nitroglycerin treatment in any case."

Do what you have support to believe in regarding your patients' wishes. If you refuse all treatment based on a DNR tattoo, you may be murdering a respected member of the Department of Natural Resources.

For the first part, I was just saying your logic is flawed. The loved one that would have cynically put the bracelet on in your example could simply speak in mine. You would choose to not listen to a bracelet but would listen to those words spoken, even though the same person did it.

I have instructions for care I want to receive in my wallet. It is also typed on my phone under the emergency contacts. I even have it written who can make medical decisions in the case that I can't make them myself. While it is true that someone could have put all that there, the chances are minimal. I sincerely hope a paramedic, nurse or physician would listen to what I wrote if they happen to find it.

And I don't see inaction as murder, especially if I had reason to believe that is what they wanted.

 

[tyrionlannister]

I have instructions for care I want to receive in my wallet. It is also typed on my phone under the emergency contacts. I even have it written who can make medical decisions in the case that I can't make them myself.

Documentation = Good
Bracelet/tattoo/meaningful look as isolated indicator of nuanced and irreversible wishes = Bad

 

[BABSstudent]

Documentation = Good
Bracelet/tattoo/meaningful look as isolated indicator of nuanced and irreversible wishes = Bad

But does the average person do this? My grandparents seem to think a bracelet is enough since it has the medical symbol. I think the person getting a tattoo on their chest saying "no code" or "Do Not Resuscitate" is thinking that they documented it in the most permanent way possible. In an accident, my phone may break, my wallet may be lost, however their skin is probably not going anywhere.

 

[Geebeejay]

Documentation = Good
Bracelet/tattoo/meaningful look as isolated indicator of nuanced and irreversible wishes = Bad

EMS does not have access to your advanced directive. If you have a bracelet/tattoo they will likely think twice before trying to resuscitate you in the field. This is where bracelets come in - they really are useless if you have the patient's medical record in front of you (in hospital)

 

[pre med 2014]

I can't see an elderly person getting a DNR tattoo around their wrist.

 

[EarthtoneJon]

Got the chills at the end of that article. Dylan Thomas!