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How Doctors Die

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Re: How Doctors Die

#41

Post by vacri »

janzer wrote: post #29
Cass wrote: post #18

To everyone considering a "NO CODE" tattoo after reading this story: Don't. If you're really that serious about not wanting to be resuscitated under any circumstances, wear some kind of bracelet or necklace with those words on it, and, just as importantly, a recent date, and contact info for a person who knows your exact wishes. Make sure to update the date regularly. Medicine changes, and so do your life circumstanc…

Not to mention that at least where I'm from a tattoo will not and cannot be accepted by EMS personnel as a valid order. Here is the relevant part from our Medical Control treatment protocols on what can be accepted as a valid do not resuscitate order: "Patient is wearing a do-not-resuscitate identification bracelet which is clearly imprinted wit the words “Do-Not-Resuscitate Order”, name and address of declarant, and…

How bizarre that they'll accept 'do not resuscitate' on jewellry, but not tattooed across the chest.

"Do we think he really meant it? Nah, he just got the tattoo - if he really meant it, he'd be wearing one of those constantly annoying bracelets"

Re: How Doctors Die

#42

Post by willyt »

danssig wrote: post #20
dcurtis wrote: post #6

I was in Best Buy earlier today and the sales guy who was trying to sell me a TV reminded me a lot of the doctors/residents I was dealing with during a few weeks I spent caring for a family member at Mass General Hospital a couple years ago. I don't think they do it consciously, but doctors try to sell you on their philosophies for healthcare. But it doesn't matter. You're sitting in a small room with dim lights and…

Well, when winning the lottery means living and losing equals the same thing as not playing; I'm going to play every single time.

Only equivalent if where you buy lottery tickets they jump over the counter and beat the crap out of you every time you buy a ticket.

Re: How Doctors Die

#43

Post by silversmith »

danssig wrote: post #20
dcurtis wrote: post #6

I was in Best Buy earlier today and the sales guy who was trying to sell me a TV reminded me a lot of the doctors/residents I was dealing with during a few weeks I spent caring for a family member at Mass General Hospital a couple years ago. I don't think they do it consciously, but doctors try to sell you on their philosophies for healthcare. But it doesn't matter. You're sitting in a small room with dim lights and…

Well, when winning the lottery means living and losing equals the same thing as not playing; I'm going to play every single time.

But it does not equal the same as not playing. The end result is the same - death. Heck, the result of all three possibilities is the same. But the difference is in the length and quality of life leading up to it.

Given the choice between now and couple years of pain later, I currently see myself choosing the former. I don't want to go through the process of becoming a disease-worn shadow of myself, and neither do I want to be remembered as one. Maybe that will change with age.

Re: How Doctors Die

#44

Post by vacri »

DanBC wrote: post #25
latch wrote: post #14

This is obviously a very personal topic, but I can't help but ask whether medecine benefits from people undergoing "futile care"? Are some diseases only treatable today because 20 years ago someone went through all the crap? The whole thing reminds me of the average mid-90s movie Phenomenon. I could always understand Travolta's character's reasoning, but I still thought it was selfish.

Science doesn't work like that. To get meaningful results you need a large sample size, with a control group, with patients not knowing whether they're getting the new medicine or the old medicine[1] and with doctors not knowing either. Then you need to write that up and analyse it. Many patients are happy to take part in such trials, but it's hard to get ethics panel approval. [1] you tend to test against current be…

Science is rigorous, repeatable observation. Double-blind studies and null hypotheses are excellent ways to achieve this. But case studies and low n studies are also informative - and are science. That science can only be control groups and null hypotheses is a myth.

Try and tell the medical fraternity that case studies should be eliminated because they hold no meaningful result and you'll be laughed out of the room.

Re: How Doctors Die

#45

Post by DavidMcLaughlin »

rbanffy wrote: post #37

I was married to a doctor for 10 years. Before that, I lived with my aunt, also a doctor. The one thing that absolutely shocked me is how they thought about aging and death. I kept reminding them their goal should be to find cures for everything, no matter how hard it seems. I approach every engineering problem as solvable. Maybe I can't solve it right now with the tools I have. Maybe I can't figure out a way to solv…

I think this is a great way to think about it. People who try everything to extend their life do not die in vain. Over ten people in my family in the last ten years have been diagnosed with cancer and so far we've only lost one. The person who didn't make it was the youngest of all the victims, but his tumour was also somewhere the doctor's didn't see that often - the bile duct near the liver.

The number of operations and suffering he had to endure still lives with me to this day and I could see why any doctor would choose not to go through this if they had to see such futile attempts at extending life end the same way. They flew in special equipment from the USA that was deemed highly experimental and would cut him open and try it out, only to have to cut him back open a few weeks later to remove what they put in. They tried surgery after surgery in the hopes something would be successful. They did not save his life but I like to think they at least learnt something about a cancer they simply don't see that often, that gave the next person a better shot. When they finally told him there was nothing more they could do, he asked them to stop all further treatment and to let him die on his terms.

The outlook for patients with breast, stomach, lung, testicular, skin or any other form of "common" cancer used to be as bad as pancreatic or bile duct cancer, but these days it's not a death sentence and a lot of people had to lose hard fought battles to get to this point.

Re: How Doctors Die

#46

Post by vaughan »

defdac wrote: post #21

Tonight I will tell the mother of our child that if I reason in any way that resembles this article she should slap me in face and tell me to fight for my life. For my daughter and my own sake. In Sweden medical care is free. I can fight as long as I want without them getting in trouble. I also suspect I should fight so hard as if the illnes is truly terminal I will end sooner in flames, not later. I want all the tub…

Here, here. I'm from Australia where medical care is also free. This idea of dying quickly as to not burden your family with medical expenses is ridiculous, given the success that single-payer health care has had in many countries all over the world.

I understand that some conditions cause insufferable pain with very slim chances of surviving, but there are many success stories from people who have battled through. Its often these same people who provide the courage to others to battle on and raise money to support the families of those who have had similar experiences. We shouldn't be thinking about optimising our lives for our own happiness, but for the generations yet to come.

I will always fight for my life to the bitter end. There is no way I would leave my children to come to grips with why their father gave up without a long, hard fight.

Re: How Doctors Die

#47

Post by ssharp »

defdac wrote: post #21

Tonight I will tell the mother of our child that if I reason in any way that resembles this article she should slap me in face and tell me to fight for my life. For my daughter and my own sake. In Sweden medical care is free. I can fight as long as I want without them getting in trouble. I also suspect I should fight so hard as if the illnes is truly terminal I will end sooner in flames, not later. I want all the tub…

"In Sweden medical care is free. I can fight as long as I want without them getting in trouble."

It's not free. It's free to you, but it is placing additional costs on the Swedish medical system, which somebody is ultimately paying for. You don't have to internalize the costs of your decision.

I'm not arguing whether or not you're a making a good or bad decision, or whether or not "free" medical care is a good thing. I'm just pointing out that providing such a system skews decision making.

Re: How Doctors Die

#48

Post by mfringel »

vacri wrote: post #41
janzer wrote: post #29

Earlier quoted context omitted.

Not to mention that at least where I'm from a tattoo will not and cannot be accepted by EMS personnel as a valid order. Here is the relevant part from our Medical Control treatment protocols on what can be accepted as a valid do not resuscitate order: "Patient is wearing a do-not-resuscitate identification bracelet which is clearly imprinted wit the words “Do-Not-Resuscitate Order”, name and address of declarant, and…

How bizarre that they'll accept 'do not resuscitate' on jewellry, but not tattooed across the chest. "Do we think he really meant it? Nah, he just got the tattoo - if he really meant it, he'd be wearing one of those constantly annoying bracelets"

What if "NO CODE" is the name of a band?

You're asking someone to make a quick life-or-death decision on ambiguous data when there is a clearly known and socially agreed upon way to express the sentiment.

Having it on an annoying bracelet that is explicitly used to signal medical intent sounds pretty good to me.

Re: How Doctors Die

#49

Post by bad_user »

rdl wrote: post #16
dcurtis wrote: post #6

I was in Best Buy earlier today and the sales guy who was trying to sell me a TV reminded me a lot of the doctors/residents I was dealing with during a few weeks I spent caring for a family member at Mass General Hospital a couple years ago. I don't think they do it consciously, but doctors try to sell you on their philosophies for healthcare. But it doesn't matter. You're sitting in a small room with dim lights and…

I can't imagine not doing #2 unless I'd also be non-functional during the extended life period. If I could read, use the Internet, write, talk to people, etc., it seems like it would be worth pain (which will end when you die, no matter what). The only case where I could see #1 being a reasonable choice is if #2 puts such hardship on those around you that their lives become much worse.

In case of chronic diseases like cancer, #2 does put hardship on those around you and their lives will become much worse.

Re: How Doctors Die

#50

Post by ck2 »

Sometimes knowing too much can be bad for choice making.

As a coder, I worry every time I drive that the computer could accidentally fire the airbags because of a bug in a poorly coded sensor (this happens far less frequently now but when airbags were first introduced people were killed/injured periodically http://news.google.com/search?q=airbag+recall+deaths ).

Not the best example but things like this do affect choicemaking and corner-cutting. It's like the fable of the plumber's plumbing, never being in good shape despite his expertise.

Hence doctors probably don't always make the best decisions about their own healthcare because they are either over-reacting, or under-reacting.

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