How Doctors Die • Hacker News Board

Re: How Doctors Die

#91

Post by DanBC » Mon, Dec 05, 2011, 4:34 PM UTC

vacri wrote: post #44

DanBC wrote: post #25

Earlier quoted context omitted.

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…

Case studies are lousy because they are not rigorous, and often have not had any meaningful result.

See also knee arthroscopy for patients with osteo arthritis - many of these surgeries were performed before a trial with a control group was possible. That trial found that people who got the sham surgery did as well as the people who got the real surgery. Case studies are lousy, often harmful, medicine.

Re: How Doctors Die

#92

Post by prodigal_erik » Mon, Dec 05, 2011, 4:44 PM UTC

vacri wrote: post #63

MrMatters wrote: post #61

Earlier quoted context omitted.

Of course, "do not resuscitate" across the chest is pretty clear of your intentions when you get it. But I don't think you realize how hard it can be to have that power over someone's life and make that call. I think the point about old tattoos is much more relevant than a band named that; if there are former neo-nazis with ultra racist/symbolic tattoos that regret them, there could be people that just got a "Do Not…

getting a tattoo isn't less annoying than a bracelet, but having a tattoo is much less annoying. In any case - where is the rash of young people with 'do not rescusitate' tattoos? Everyone I've seen that is supposed to have had one is a greyhair, well out of the young-and-dumb age. And even if you do 'later regret' the tatt and don't want to stump for tatt removal, just tatt a couple of lines through it or tatt somet…

I would prefer we avoid shooting the messengers. Even if there's an argument that EMTs should honor indelible express wishes, we can't have this debate with all of them simultaneously. We are being informed that many of the ones out there today will not, which never would have occurred to me, and knowing that has some value.

Re: How Doctors Die

#93

Post by iguanayou » Mon, Dec 05, 2011, 4:44 PM UTC

Is it possible that "get medical treatment" or "go in peace" is a false dichotomy?

Re: How Doctors Die

#94

Post by philwelch » Mon, Dec 05, 2011, 4:58 PM UTC

andrewmu wrote: post #54

vacri wrote: post #40

Earlier quoted context omitted.

Telling people to give up because of money or some sort of gentleness to yourself or your family is alien to me. Maybe it's our harsh climate uphere. Swedes seems very in tune with our suffering. It's not about being tough and macho. A lingering decline can be psychologically painful for everyone involved. Pretty much everyone I know that has been involved in caring for someone who suffered a slow decline - particula…

A lingering death can sometimes be easier for those round about you, to some extent. They know what's happening, get a chance be resigned to the future, but still talk to you before the end. And if it's painful, they can feel relief that your suffering is over. When you die quickly, you personally don't suffer, but those around you are stunned by the sudden, often unexpected loss and life. It seems cruel and arbitrar…

My mother died of a sudden heart attack at home. It was so sudden that she seemed perfectly fine that very afternoon and evening according to everyone who had seen her that day. It was a shock to hear about. On the other hand, my father died, unconscious and hospitalized, after a week of unsuccessfully trying to recover from emergency surgery after months of intensive medical treatment and going in and out of hospitals. Speaking from experience, I think a sudden death is far less cruel to your loved ones. At the very least, it doesn't require them to make tough decisions.

You never get a choice, though. Some people, like my father, survive their first heart attack with no apparent long term damage while others, like my mother, don't. Some people get cancer. Some people even get hospitalized for things that aren't life-threatening--but when something life-threatening does happen, those medical problems become obstacles to effective treatment.

Re: How Doctors Die

#95

Post by jballanc » Mon, Dec 05, 2011, 4:59 PM UTC

andrewmu wrote: post #54

vacri wrote: post #40

Earlier quoted context omitted.

Telling people to give up because of money or some sort of gentleness to yourself or your family is alien to me. Maybe it's our harsh climate uphere. Swedes seems very in tune with our suffering. It's not about being tough and macho. A lingering decline can be psychologically painful for everyone involved. Pretty much everyone I know that has been involved in caring for someone who suffered a slow decline - particula…

A lingering death can sometimes be easier for those round about you, to some extent. They know what's happening, get a chance be resigned to the future, but still talk to you before the end. And if it's painful, they can feel relief that your suffering is over. When you die quickly, you personally don't suffer, but those around you are stunned by the sudden, often unexpected loss and life. It seems cruel and arbitrar…

It may seem counterintuitive, but I think the opposite is true. Think about it: what will people remember about you? If your death is relatively quick, the majority of their memories will be of happier times spent with you in good health. On the other hand, if you have a long, drawn-out, multi-year struggle, that will be what they remember most.

I don't have the link handy, but there was a study a while back comparing hospice care to class 3 chemo (that's the really, really poisonous bad stuff). The study found that families of those who went into hospice coped better with the loss. Furthermore, almost counterintuitively, those in hospice care actually lived longer on average. Sometimes, taking stress off the body gives it just enough room to keep fighting on its own a bit longer...

Re: How Doctors Die

#96

Post by tibbon » Mon, Dec 05, 2011, 5:07 PM UTC

ssharp wrote: post #47

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.…

Free or not, it seems to work pretty well for the citizens there. You don't have a sizable portion of the population filing bankruptcy over medical bills and they haven't gone bankrupt like Greece. Something Sweden is doing is right.

Re: How Doctors Die

#97

Post by jballanc » Mon, Dec 05, 2011, 5:07 PM UTC

For everyone contemplating the prospect of hospice care vs "fight to the very end", this study might be of interest [PDF]: http://www.nhpco.org/files/public/jpsm/march-2007-article.pd...

The salient point:

> For the six patient populations combined, the mean survival was 29 days longer for hospice patients than for nonhospice patients.

Re: How Doctors Die

#98

Post by rbanffy » Mon, Dec 05, 2011, 5:15 PM UTC

gravitronic wrote: post #83

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…

Every single one of us are going to die at some point. If you were a doctor and your goal is to "find cures for everything" then your eventual success rate over your career would be 0. Do you realize how hard it would be to do that for your entire career if you approached it thinking you could beat cancer? You don't say in your post if your relatives were practitioners or research doctors, but if you're putting it on…

Since my father died, 43 years ago, many types of cancer were defeated. He wouldn't die today - he would undergo chemotherapy, radiotherapy or surgery, would go bald, but would live to see his grandchildren.

Re: How Doctors Die

#99

Post by radu_floricica » Mon, Dec 05, 2011, 5:18 PM UTC

iguanayou wrote: post #93

Is it possible that "get medical treatment" or "go in peace" is a false dichotomy?

Of course it is. The dichotomy is between going in peace and doing absolutely everything possible, regardless of costs, to live a bit more.

Re: How Doctors Die

#100

Post by philwelch » Mon, Dec 05, 2011, 5:20 PM UTC

Jach wrote: post #51

VMG wrote: post #19

One alternative that hasn't been mentioned here is cryopreservation. Once I have the resources and the technology has progressed, I'd certainly choose that option above being treated and "NO CODE".

Totally on board with cryonics, it's really depressing that it gets swept under the rug considering it probably has at least 5% chance of working for a patient suspended today. Though your excuses for presently avoiding it seem pretty flimsy unless you're really dirt poor (I'd wager unlikely), especially when life insurance payable to the cryonics company is cheap (you only need $28-$35k for CI) and so are membership…

Setting aside how completely fictitious that 5% is, here are my problems:

1. Cryonics is the sci-fi version of Pascal's Wager. If cryonics is rational, than by the same reasoning so is Christianity.

2. Cryonics doesn't guarantee quality of life. If the brain is poorly preserved, you might be woken up in the far future with profound and irreparable dementia. And I mean "irreparable" not in relation to the limitations of medical science at a given future date, but in a purely information-theoretic sense. There might not be enough information left in your flash-frozen brain.

3. Cultures don't evolve because people change their minds, they evolve because people die and become outnumbered. If there's one thing the future doesn't need, it's us. And likewise, I think we would be shocked by the future.

4. Even if cryonics is theoretically feasible, I would need pretty good assurance that the cryonics company weren't charlatans. The news so far on that front isn't promising.