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How Doctors die. It’s not like the rest of us (2016)

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Re: How Doctors die. It’s not like the rest of us (2016)

#111

Post by Sam6late »

My mother died last month,I have seen that same costly futile care before when it was performed on my father two decades before, but we had no choice. Both were injected with a dozen drugs syringes and perforated with tubes, hooked up to machines.

Although I am somewhat healthy, yet looking at rocking 60 made me contemplate and feel contentment just upon reading about psilocybin for patients dealing with life-threatening diagnoses, end-of-life anxiety (plus a dozen documentaries and 2 on Netflix). Learning about it has offered me relief and lasting drop in existential distress, especially as it helps melt the ego into everything. https://pmc.ncbi.nlm.nih.gov/articles/PMC9833165/

Re: How Doctors die. It’s not like the rest of us (2016)

#112

Post by zemvpferreira »

xandrius wrote: post #107
zemvpferreira wrote: post #87

Earlier quoted context omitted.

The father of a good friend passed away recently from a brain cancer. He was a doctor, but atypically accepted every treatment available. His last 3 years were spent in surgery or sick from chemo, did not have one good day after his initial diagnosis. If he could have gone back I'm sure he would have decided not to be treated.

Unless going back gets you to re-roll your dice then I'm sure they would still have done it.

You might not want it for yourself but many people, especially health professionals in my experience, will take a smaller but less painful lifespan over a chance to live longer through horrible treatments.

Re: How Doctors die. It’s not like the rest of us (2016)

#113

Post by devonsolomon »

I worked for some years in cancer prevention.

Last year, my mom was diagnosed with Stage 4 cancer. My family largely agrees with this article: treatment was a mistake and likely worse than the disease (bar palliative care and a stent).

The headline we used in cancer education is about 38% of cancer cases are likely caused and perhaps preventable by modifiable lifestyle factors: Tabbaco, infections, alcohol, UV.

Widespread vaccination (HPV, Hep B/C etc) and precision prevention (genetic counseling and preventative interventions) add another layer of preventative opportunity, and could significantly move the needle inclusive of and beyond/above lifestyle factors.

This leaves a lot of room for change, but requires a changing of economic incentives and cultural factors: which are incredibly slow moving ships.

The next layer is early detection (pre-cancer and early cancer); and technology advancements look promising - multi-cancer blood tests like Galleri and whole-body MRI (Prenuvo, Neko, Midjourney) are scientifically and economically promising, but all commercially ahead of their time.

These two additional pots potentially provide another significant opportunity to reduce the burden where the cost-benefit on personal suffering makes sense.

I’d add as the last personal suffering cost-benefit promising intervention layer targeted immunotherapy (and perhaps to a lesser extent ADCs/smart-bombs), where many patients enjoy results without bearing equal or exceeding suffering. Though with smart bombs, the maths isn’t as convincing, and with both you’re heading into lower odds bets.

Ofcourse, many people are helped by classical chemo, but much of the time (and especially in later stages) you’re hoping to be the exception, and at this point, the population wide experience is in many cancer types net negative.

Many people pin there hopes on this last, narrow category of intervention for breakthroughs; and hopefully they come; but likely this hope, attention and capital is misplaced.

Re: How Doctors die. It’s not like the rest of us (2016)

#114

Post by krisoft »

bonsai_spool wrote: post #8
j-conn wrote: post #3

Earlier quoted context omitted.

Totally misleading. Early CPR (+AED if available) absolutely saves lives. Article is from 2011 by a family med doctor. Overly aggressive resuscitation attempts are definitely a problem but context matters

> Early CPR (+AED if available) absolutely saves lives. Article is from 2011 by a family med doctor. You have to provide a denominator to make this statement. 30-day survival for out-of-hospital CPR is 10%, and discharge from the hospital (let alone functional status) is even lower. CPR is thus a great example of the OP's thesis that doctors refuse certain things based on their poor efficacy. https://www.redcross.org…

> 30-day survival for out-of-hospital CPR is 10%

Okay. And what is the 30-day survival for cases where CPR would be otherwise indicated but are not performed?

It is a bit like complaining that jumping out of a burning airplane with a parachute is dangerous. Yes, it is. But jumping out of a parachute, or burning inside, is even more dangerous.

Re: How Doctors die. It’s not like the rest of us (2016)

#115

Post by TomMasz »

As the article points out, CPR really is oversold. I was a volunteer firefighter and did CPR multiple times, none of those people survived. I watched (and listened) as firefighters did CPR on my wife after she had a massive heart attack, hanging on to some hope but knowing deep down it was futile. But they transported her to emergency anyway.

I watched my father slowly die from sepsis that began with an infection in a toe. Surgery to improve leg circulation failed and his toe was amputated. The antibiotics not only induced the sepsis but led to a C. difficile infection. His mind deteriorated almost overnight. My mom couldn't make the decision to end care and place him in hospice, so the decision was passed to me. He had made his care wishes clear in writing, so while it was a hard decision, I knew it's what he wanted. He died less than a day later.

I'm working on my own care directives so my kids know exactly what to do when it's my time. With luck, they'll be able to ensure those directives are followed.

Re: How Doctors die. It’s not like the rest of us (2016)

#116

Post by tsimionescu »

dj_gitmo wrote: post #24
ourmandave wrote: post #16

Earlier quoted context omitted.

This reminds me of an interview with neurosurgeon and author Henry Marsh who had prostate cancer. He described how he's arranged to end his own life should he get alzheimer's or dementia as he didn't want to waste away. But he explained that he has access to knowledge and things ordinary people don't.

I looked into this recently and it seems like it is basically impossible to pre-arrange assisted suicide for alzheimer's or dementia. Even in countries which allow death with dignity. I find it very strange because it’s so common and I’m sure many people would prefer DWD in those circumstances.

The big problem with Alzheimer or dementia is related to consent and timing. People's memory dissolves pretty slowly. You'd almost certainly not want to be euthanized when you've just started forgetting where you've put your keys more often. Many would rather be euthanized than continue being a burden when they have stopped even remembering that bathrooms exist or who their family was. Between these extremes you can have many years, maybe even a decade, of good and bad days, weeks, months.

Re: How Doctors die. It’s not like the rest of us (2016)

#117

Post by Someone »

buran77 wrote: post #109
teiferer wrote: post #92

Earlier quoted context omitted.

Agreeing with your overall sentiment, but this caught my eye: > If I'm 80, I'm (somewhat) less concerned with length of life, and more concerned with quality. If I'm 50 that's a different equation Why is that? Is quality less important at 50? Would you be more willing to endure suffering if you are younger? Why? I'm thinking that no matter age, people would generally like to avoid a painful death. Maybe it's because…

> Why is that? By 80 most people have reconciled with the idea that they don't have too many years left even in the best of conditions. There's no hope of extending life, and there's little to look forward to, they already lived through all the important milestones they could realistically see. Quality is all that's left to hope for. At 50 they still can still hope for recovery and a life beyond that. They have a lot…

> By 80 most people have […] already lived through all the important milestones they could realistically see.

That’s at least partially culturally determined. As the healthy live expectancy creeps up slowly, I expect that idea to change. There’s some truth in the saying “50 is the new 40”

Re: How Doctors die. It’s not like the rest of us (2016)

#118

Post by KellyCriterion »

dj_gitmo wrote: post #24
ourmandave wrote: post #16

Earlier quoted context omitted.

This reminds me of an interview with neurosurgeon and author Henry Marsh who had prostate cancer. He described how he's arranged to end his own life should he get alzheimer's or dementia as he didn't want to waste away. But he explained that he has access to knowledge and things ordinary people don't.

I looked into this recently and it seems like it is basically impossible to pre-arrange assisted suicide for alzheimer's or dementia. Even in countries which allow death with dignity. I find it very strange because it’s so common and I’m sure many people would prefer DWD in those circumstances.

In Switzerland, there are four agencies - one treats foreigners as well (Pegasos Association)

Re: How Doctors die. It’s not like the rest of us (2016)

#119

Post by hobo123 »

____tom____ wrote: post #25

On the spectrum or go gentle vs fight, I'd have to say, now is the time is history where "fight" makes the most sense. This is not abstract for me. I have not one, but two forms of cancer. Both were considered incurable when I was diagnosed. Both have treatments now that, IN SOME PEOPLE, lead to remission. I still don't know which group I am, but I'd be dead from either one by now, if I hadn't elected to treat. New t…

The question to ask is: did those people who got remission do so because of the treatment, because of something else, or despite treatment?

It seems to me that much of modern chemotherapy is rather barbaric, but this is very much an outside view.

Wish you all the best, with medicine, or without.

Re: How Doctors die. It’s not like the rest of us (2016)

#120

Post by voiper1 »

jrapdx3 wrote: post #19

I'm a physician, an old one. We're lucky to live as long as we do, but life will end. The article emphasizes the value of dying peacefully. Sure, that's how we want it to be, but we have to make it known to assure it goes that way. Don't know what happens elsewhere, but every time I see a doctor someone asks if I have a signed, notarized directive. Yes, I've done that, but so should everybody else concerned about the…

>At least I've done what I can do, but we can't save people from themselves.

Why should doctors NEED to save people from themselves?

The default should be what the people in the industry have learned, with full permission to say "For myself, I have written a legally binding document that this is my personal wishes. I suggest you make that decision for your loved one, too."

Patients have the ability to ask for more, but there shouldn't be a constant need to save people from inadvertently choosing risky/painful low payoff medical care!

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