8 ms·

How Doctors Die (2011)

132 points by known 10y ago

swiley 10y ago
The format of this page actually makes it very difficult to do anything but skim because the social media buttons on the lft cover up the ~ the first word of every line.
- gcb0 10y ago
  reads perfectly with NoScript ;)
  - theandrewbailey 10y ago
    Or go into the inspector and delete the offending node! I resort to that sometimes when the "loading" message obscures the (already loaded) content, but won't go away because no JS.
    - gcb0 10y ago
      no script is the only realistic option on mobile though :(
neaden 10y ago
A living will (and a regular will too off course) is a blessing for your family as well. Make your end of life care decisions now so your loved ones don't have the burden of deciding them for you in case you are unable to make these decisions. And talk to your family as well so they know your wishes, even if you are young you never know what tomorrow will bring.
- athenot 10y ago
  Yes! We'll all die one day. We don't have to be pessimistic and gloomy about it but we do need to prepare. We all hope it won't be right away but yet there's no guarantee in life. Everyone has different priorities when things get rough, but without planning, the regular defaults apply, and they (usually) aren't what you or your family want.
woliveirajr 10y ago
>When doctors ask if they want “everything” done, they answer yes. Then the nightmare begins. > But doctors still don’t over-treat themselves. This is an interesting article. The main point is that nobody, in general, is prepared to be in a almost-dead situation, and when this event comes, the patient nor family is prepared to answer "ok, I prefer more life quality than trying all possible treatments". Because the implicit answer is that when you give up all alternatives, you are saying "I prefer to live few months and die". Not that choosing all treatments might be different. But it's a possibility, it's a try, and it's not "giving up". Doctors, on the other hand, deal and see all the side effects of the treatment. They know what will cost (in quality, not only money). And if the end will come anyway...
- robbiep 10y ago
  As a doctor, when I am running through an Advanced Care Directive (ACD, what a DNR order is called in NSW Public hospitals) (I do it with all patients older than 70 that present to the emergency room), if they say they want 'everything', I say, yes, we will do everything that is in your best interests. But let's think about this case. If your condition was to deteriorate and your heart was to stop, would you like CPR? This would break all your ribs and also require a breathing machine. What about if you were to stop breathing and require a machine to breathe for you? Would you like to be attached to a ventilator? What about if you could not feed yourself? Would you want a feeding tube inserted? Often by making people confront the actuality of what resuscitation means, you can change their ACD to something that is both medically appropriate for their condition and satisfactory for them, as they may have never thought about it in the terms you are describing it
MrFoof 10y ago
>Some medical personnel wear medallions stamped “NO CODE” to tell physicians not to perform CPR on them. I have even seen it as a tattoo. I've had many doctors indicate to me that if they find this on someone coming into the ICU, most hospitals will still attempt to resuscitate. It's a "damned if you do, damned if you don't" situation. If you don't attempt to resuscitate, the patient's family may sue for letting them die and not attempting resuscitation. Granted, if you do resuscitate, you may be sued by the patient. Most hospitals feel there is far lower risk if they resuscitate, so "NO CODE" or "DNR" tattooed on your chest will likely be ignored.
- yaakov34 10y ago
  Yeah, as a former volunteer EMT, I'd like to ask you not to do this. The rules vary by country and by state in the US; e.g. I can tell you that in New Jersey as of 10 years ago, there was a standard document (DNR order) which needed to be signed by the doctor and the patient or the legal guardian, which needed to be available to the EMS crew. In any case, I haven't heard that anywhere, a tattoo or bracelet or necklace is legally sufficient, although it may be in your jurisdiction. You'd be putting the EMS crew in a very tough spot: believe me, nobody wants to do pointless resuscitations on people who don't want them, but there are usually very specific policies and laws about when an EMS crew can stop or not attempt resuscitation, and if they aren't met, it's really hard for me to see how an ambulance crew can follow your (apparent) wishes. On a more positive note, I don't think that DNR orders make sense for people without advanced disease, or who are not elderly and in poor health. For the healthier people, an out-of-hospital cardiac arrest is more likely to be caused by something like blood loss in an accident or by electric shock, or by relatively fixable arrhythmias and heart disease. I don't see a reason to prevent the emergency crew and the hospital from giving you a chance.
  - EvanAnderson 10y ago
    Would my having the properly signed copy of a DNR on my person at all times (along with some kind of placard to indicate where on my person it is) be sufficient in your opinion?
gcb0 10y ago
the irony is that most surgery advances that ends up saving a life 100% of the time with good quality of life, only get discovered because of thousands of people demanding the 5% with bad quality of life if it even succeds. and surgeons love to practice the difficult cases because, as the article mentions, that's how they make a name for themselves.
klenwell 10y ago
This Radiolab story (2013) covers the same theme: http://www.radiolab.org/story/262588-bitter-end/ http://www.radiolab.org/story/262588-bitter-end/ It notes the discrepancy between doctors' preferences and the general public's and points to the role television medical dramas play in explaining it. I've always been in the "If I'm too ill to enjoy life, please let me go" camp. Still, this was one of those pieces that significantly tilted how I look at an issue.
- gmarx 10y ago
  Many people think that when they see an ill person. I wouldn't want to live like that. In reality it sneaks up on you so slowly that by the time you are in that situation, you do want to live like that. My dad saw his dad slowly die of dementia and told me he wanted to get a cyanide pill and always have it on him. When he got in that condition and was restricted to bed in a nursing home and we asked if he wanted DNR, he was pretty clear that he did not. One could argue whether he understood. The only patient I ever saw who was eager to die was an end stage lung patient with horrible air hunger. He said enthusiastically "doc, let's do this" (he meant give me enough morphine for the air hunger that I stop breathing). It was kind of chilling
  - maxxxxx 10y ago
    I have been thinking about this too and I also concluded that it will be hard to find the cutoff point. Most diseases take years to develop. How do you decide you had enough?
    - gmarx 10y ago
      If you go via dementia by the time you get there you long ago lost the ability to act
  - ZeroFries 10y ago
    More like fear is not present when they make that decision for "future me", and is present when making that decision for "present me".
hprotagonist 10y ago
The 2014 Reith Lecture, given by Atul Gawande, addresses these issues in great depth. Well worth a listen. http://www.bbc.co.uk/programmes/b04bsgqn http://www.bbc.co.uk/programmes/b04bsgqn
phn 10y ago
I guess it's only natural. I don't expect non-technical people to make the same technical choices I do, nor can I recommend them to the general population. I suspect that it's the same with doctors, but their field happens to be the workings of disease and their treatments.
paulddraper 10y ago
I imagine the letters to the left are important, but I guess I won't know for sure, because of social media.
acqq 10y ago
Also worth checking the "past" link, there are a few hundreds of comments already. https://hn.algolia.com/?query=How%20Doctors%20Die&sort=byDate&dateRange=all&type=story&storyText=false&prefix&page=0 https://hn.algolia.com/?query=How%20Doctors%20Die&sort=byDat...
dhimes 10y ago
Whaaaaaat is going on here? This article is from the Atlantic. Edit: Saturday Evening Post http://www.saturdayeveningpost.com/2013/03/06/in-the-magazine/health-in-the-magazine/how-doctors-die.html http://www.saturdayeveningpost.com/2013/03/06/in-the-magazin...
jrumbut 10y ago
This has been a pretty controversial article, because the evidence supporting the author's claims is not terribly good. One of his key studies relied on people who volunteered, while in med school, to participate in a study that would continue as they aged and died. It's not hard to imagine this group was more comfortable thinking about mortality than most doctors. Certainly more doctors than members of the general public have things like living wills that simplify end of life care than the average person, however more people who make as much money and have as much education as doctors also have living wills more often than the general public. I haven't been able to find numbers for doctors compared to, say, lawyers or professors. There does seem to be a subculture among doctors who are looking into how to die well, and may be better at it and act on their beliefs with greater confidence and urgency than those who don't encounter death as often, but it seems like many, if not most, doctors cling to life and try to delay the inevitable like the rest of us. For some additional data, see here: https://www.sciencebasedmedicine.org/doctors-and-dying/ https://www.sciencebasedmedicine.org/doctors-and-dying/
unixhero 10y ago
Depression trigger warning
- 1_2__3 10y ago
  This isn't Tumblr.
  - unixhero 10y ago
    We are not machines. We are men.
mathattack 10y ago
It's a very tough issue. My parents both asked to not have extensive life maintenance due to issues they had with their parents. It's best to have the discussion with next of kin in advance.
amelius 10y ago
One of the best types of death one can wish for is one on a bed, with morphine, and slowly overdosing on it. I guess most doctors can arrange this kind of situation, should the need arise. I can also imagine that doctors keep this in mind during their lives, but then because of practical concerns, they still die the normal way.
kolbe 10y ago
Assuming this article is accurate, it shows what type of a clownish dystopia the USA has found itself in. We force the government (i.e. the collective US citizens) to pay for end of life treatment for people who didn't budget for it themselves, and which also appears to offer a worse utility than doing nothing according to the revealed preferences of the very people who are responsible for administering these treatments. That is, we are bankrupting our nation to make people more miserable.

132 points by known 10y ago

The format of this page actually makes it very difficult to do anything but skim because the social media buttons on the lft cover up the ~ the first word of every line.

gcb0 10y ago
reads perfectly with NoScript ;)
- theandrewbailey 10y ago
  Or go into the inspector and delete the offending node! I resort to that sometimes when the "loading" message obscures the (already loaded) content, but won't go away because no JS.
  - gcb0 10y ago
    no script is the only realistic option on mobile though :(

neaden 10y ago

A living will (and a regular will too off course) is a blessing for your family as well. Make your end of life care decisions now so your loved ones don't have the burden of deciding them for you in case you are unable to make these decisions. And talk to your family as well so they know your wishes, even if you are young you never know what tomorrow will bring.

athenot 10y ago
Yes! We'll all die one day. We don't have to be pessimistic and gloomy about it but we do need to prepare. We all hope it won't be right away but yet there's no guarantee in life. Everyone has different priorities when things get rough, but without planning, the regular defaults apply, and they (usually) aren't what you or your family want.

woliveirajr 10y ago

>When doctors ask if they want “everything” done, they answer yes. Then the nightmare begins. > But doctors still don’t over-treat themselves. This is an interesting article. The main point is that nobody, in general, is prepared to be in a almost-dead situation, and when this event comes, the patient nor family is prepared to answer "ok, I prefer more life quality than trying all possible treatments". Because the implicit answer is that when you give up all alternatives, you are saying "I prefer to live few months and die". Not that choosing all treatments might be different. But it's a possibility, it's a try, and it's not "giving up". Doctors, on the other hand, deal and see all the side effects of the treatment. They know what will cost (in quality, not only money). And if the end will come anyway...

robbiep 10y ago
As a doctor, when I am running through an Advanced Care Directive (ACD, what a DNR order is called in NSW Public hospitals) (I do it with all patients older than 70 that present to the emergency room), if they say they want 'everything', I say, yes, we will do everything that is in your best interests. But let's think about this case. If your condition was to deteriorate and your heart was to stop, would you like CPR? This would break all your ribs and also require a breathing machine. What about if you were to stop breathing and require a machine to breathe for you? Would you like to be attached to a ventilator? What about if you could not feed yourself? Would you want a feeding tube inserted? Often by making people confront the actuality of what resuscitation means, you can change their ACD to something that is both medically appropriate for their condition and satisfactory for them, as they may have never thought about it in the terms you are describing it

MrFoof 10y ago

>Some medical personnel wear medallions stamped “NO CODE” to tell physicians not to perform CPR on them. I have even seen it as a tattoo. I've had many doctors indicate to me that if they find this on someone coming into the ICU, most hospitals will still attempt to resuscitate. It's a "damned if you do, damned if you don't" situation. If you don't attempt to resuscitate, the patient's family may sue for letting them die and not attempting resuscitation. Granted, if you do resuscitate, you may be sued by the patient. Most hospitals feel there is far lower risk if they resuscitate, so "NO CODE" or "DNR" tattooed on your chest will likely be ignored.

yaakov34 10y ago
Yeah, as a former volunteer EMT, I'd like to ask you not to do this. The rules vary by country and by state in the US; e.g. I can tell you that in New Jersey as of 10 years ago, there was a standard document (DNR order) which needed to be signed by the doctor and the patient or the legal guardian, which needed to be available to the EMS crew. In any case, I haven't heard that anywhere, a tattoo or bracelet or necklace is legally sufficient, although it may be in your jurisdiction. You'd be putting the EMS crew in a very tough spot: believe me, nobody wants to do pointless resuscitations on people who don't want them, but there are usually very specific policies and laws about when an EMS crew can stop or not attempt resuscitation, and if they aren't met, it's really hard for me to see how an ambulance crew can follow your (apparent) wishes. On a more positive note, I don't think that DNR orders make sense for people without advanced disease, or who are not elderly and in poor health. For the healthier people, an out-of-hospital cardiac arrest is more likely to be caused by something like blood loss in an accident or by electric shock, or by relatively fixable arrhythmias and heart disease. I don't see a reason to prevent the emergency crew and the hospital from giving you a chance.
- EvanAnderson 10y ago
  Would my having the properly signed copy of a DNR on my person at all times (along with some kind of placard to indicate where on my person it is) be sufficient in your opinion?

gcb0 10y ago

the irony is that most surgery advances that ends up saving a life 100% of the time with good quality of life, only get discovered because of thousands of people demanding the 5% with bad quality of life if it even succeds. and surgeons love to practice the difficult cases because, as the article mentions, that's how they make a name for themselves.

klenwell 10y ago

This Radiolab story (2013) covers the same theme: http://www.radiolab.org/story/262588-bitter-end/ http://www.radiolab.org/story/262588-bitter-end/ It notes the discrepancy between doctors' preferences and the general public's and points to the role television medical dramas play in explaining it. I've always been in the "If I'm too ill to enjoy life, please let me go" camp. Still, this was one of those pieces that significantly tilted how I look at an issue.

gmarx 10y ago
Many people think that when they see an ill person. I wouldn't want to live like that. In reality it sneaks up on you so slowly that by the time you are in that situation, you do want to live like that. My dad saw his dad slowly die of dementia and told me he wanted to get a cyanide pill and always have it on him. When he got in that condition and was restricted to bed in a nursing home and we asked if he wanted DNR, he was pretty clear that he did not. One could argue whether he understood. The only patient I ever saw who was eager to die was an end stage lung patient with horrible air hunger. He said enthusiastically "doc, let's do this" (he meant give me enough morphine for the air hunger that I stop breathing). It was kind of chilling
- maxxxxx 10y ago
  I have been thinking about this too and I also concluded that it will be hard to find the cutoff point. Most diseases take years to develop. How do you decide you had enough?
  - gmarx 10y ago
    If you go via dementia by the time you get there you long ago lost the ability to act
- ZeroFries 10y ago
  More like fear is not present when they make that decision for "future me", and is present when making that decision for "present me".

hprotagonist 10y ago

The 2014 Reith Lecture, given by Atul Gawande, addresses these issues in great depth. Well worth a listen. http://www.bbc.co.uk/programmes/b04bsgqn http://www.bbc.co.uk/programmes/b04bsgqn

phn 10y ago

I guess it's only natural. I don't expect non-technical people to make the same technical choices I do, nor can I recommend them to the general population. I suspect that it's the same with doctors, but their field happens to be the workings of disease and their treatments.

paulddraper 10y ago

I imagine the letters to the left are important, but I guess I won't know for sure, because of social media.

acqq 10y ago

Also worth checking the "past" link, there are a few hundreds of comments already. https://hn.algolia.com/?query=How%20Doctors%20Die&sort=byDate&dateRange=all&type=story&storyText=false&prefix&page=0 https://hn.algolia.com/?query=How%20Doctors%20Die&sort=byDat...

dhimes 10y ago

Whaaaaaat is going on here? This article is from the Atlantic. Edit: Saturday Evening Post http://www.saturdayeveningpost.com/2013/03/06/in-the-magazine/health-in-the-magazine/how-doctors-die.html http://www.saturdayeveningpost.com/2013/03/06/in-the-magazin...

jrumbut 10y ago

This has been a pretty controversial article, because the evidence supporting the author's claims is not terribly good. One of his key studies relied on people who volunteered, while in med school, to participate in a study that would continue as they aged and died. It's not hard to imagine this group was more comfortable thinking about mortality than most doctors. Certainly more doctors than members of the general public have things like living wills that simplify end of life care than the average person, however more people who make as much money and have as much education as doctors also have living wills more often than the general public. I haven't been able to find numbers for doctors compared to, say, lawyers or professors. There does seem to be a subculture among doctors who are looking into how to die well, and may be better at it and act on their beliefs with greater confidence and urgency than those who don't encounter death as often, but it seems like many, if not most, doctors cling to life and try to delay the inevitable like the rest of us. For some additional data, see here: https://www.sciencebasedmedicine.org/doctors-and-dying/ https://www.sciencebasedmedicine.org/doctors-and-dying/

unixhero 10y ago

Depression trigger warning

1_2__3 10y ago
This isn't Tumblr.
- unixhero 10y ago
  We are not machines. We are men.

mathattack 10y ago

It's a very tough issue. My parents both asked to not have extensive life maintenance due to issues they had with their parents. It's best to have the discussion with next of kin in advance.

amelius 10y ago

One of the best types of death one can wish for is one on a bed, with morphine, and slowly overdosing on it. I guess most doctors can arrange this kind of situation, should the need arise. I can also imagine that doctors keep this in mind during their lives, but then because of practical concerns, they still die the normal way.

kolbe 10y ago

Assuming this article is accurate, it shows what type of a clownish dystopia the USA has found itself in. We force the government (i.e. the collective US citizens) to pay for end of life treatment for people who didn't budget for it themselves, and which also appears to offer a worse utility than doing nothing according to the revealed preferences of the very people who are responsible for administering these treatments. That is, we are bankrupting our nation to make people more miserable.