The Wall Street Journal has published an intriguing piece contrasting the attempts doctors make to preserve their own life compared to how they treat their their patients, explaining why doctors don't often take the same measures that they perform on others.
It's not something that we like to talk about, but doctors die, too. What's unusual about them is not how much treatment they get compared with most Americans, but how little. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care that they could want. But they tend to go serenely and gently.
The piece reminded me of the 2010 piece from the New Yorker on hospice care, showing how in ordinary medicine, the goal is to extend life rather than hospice care's focus on quality of life. Religion naturally plays a pretty strong role in cultural discussions about life and death, but the rationale the author provides for doctors' attitudes is more medical than anything else.
During their last moments, they know, for instance, that they don't want someone breaking their ribs by performing cardiopulmonary resuscitation (which is what happens when CPR is done right).
In a 2003 article, Joseph J. Gallo and others looked at what physicians want when it comes to end-of-life decisions. In a survey of 765 doctors, they found that 64% had created an advanced directive—specifying what steps should and should not be taken to save their lives should they become incapacitated. That compares to only about 20% for the general public.
How did we get to this point? I wonder if Google has something to do with it where patients (and patients' families) are likely researching options more than ever.
Unlike previous eras, when doctors simply did what they thought was best, our system is now based on what patients choose. Physicians really try to honor their patients' wishes, but when patients ask "What would you do?," we often avoid answering. We don't want to impose our views on the vulnerable.
The result is that more people receive futile "lifesaving" care, and fewer people die at home than did, say, 60 years ago.
If the author had more room for follow up, perhaps it would have been appropriate to explore questions religion and belief in preparing for death. Questions about suffering, grief, whether there is an after life naturally come to the forefront for people who face serious illness.
Beyond scientific explanations for why doctors carry a level of acceptance that patients don't normally have, are doctors more or less religious than the general population? Would that impact whether they might seek or not seek more treatment? For instance, a study a few years ago suggested that cancer patients who are religious are more likely to seek measures that attempt to prolong life.
The piece is interesting, but it still leaves us with some of the "why" question. Exploring belief could be a way to explain motivations.
Image via Wikimedia Commons.