In 2011, an essay about how doctors face their own death went viral. The author, Ken Murray, M.D., Clinical Assistant Professor of Family Medicine at USC, asserted that doctors’ knowledge of the cost and benefits of procedures at the end of life keeps physicians from pressing for extra days on this earth.
Because doctors know that many procedures used to keep people alive do little to benefit patients' quality of life, Murray explains that the decision of how to best care for patients at the end of their life is a complicated matter. Doctors must think outside of what the patient wants, also taking into consideration what the patient’s family wants and what the system dictates. He tells a story about one of his patients who didn’t want to be put on life support, no matter what, but ended up on life support anyway because there was no one to speak for him when he was taken to the hospital. Murray writes, “in many ways all the parties are simply victims of a larger system that encourages excessive treatment.”
The powerful essay posits that most doctors, given what they know about end of life procedures, choose to go quietly into the night, not wanting any extra medical care.
Fast forward 5 years later, and new research is showing there is actually no clinically significant difference in end of life care and choices whether the patient is a doctor or not.
The study, published in The Journal of the American Geriatrics Society, examined 200,000 Medicare beneficiaries. It found that the majority of people, whether physicians or not, were hospitalized in their last 6 months of life. Additionally, the same amount of people had at least one ICU visit during this time frame.
Although there was no clinically significant difference, the study did show doctors spent more time in the ICU than others, suggesting doctors may be using medicine more intensely. The study also showed that doctors are more likely to use hospice care more often and for longer than their non-physician counterparts. However, this was also a non-significant difference.
What is interesting about this is that the results are opposite of what doctors say they want at the end of their life.
Given the results of this study, it seems like doctors die the same way all the rest of us do. What is interesting about this is that the results are opposite of what doctors say they want at the end of their life. In a survey published in the Journal of General Internal Medicine, most doctors stated they would choose less medical treatment than compared to their patients. The results of this study were significant.
This discrepancy between what doctors say they want and what actually happens at the end of their life begs the question, “What changes?”
Daniel Matlock, lead researcher of the study published in The Journal of the American Geriatrics Society, says, "Doctors are human, too, and when you start facing these things, it can be scary, and you can be subject to these cognitive biases.”
However, Matlock and his colleagues believe the results of this study are indicative of the larger health care system. Currently, our healthcare system is aimed at fixing problems, and the system may override even the most strong willed, educated patients.
"These things that encourage low-value care at the end of life are big systems issues," Matlock said. "And a strong, informed patient who knows the risks and benefits — maybe even they have a hard time stopping the train."
Aptly named, Enclothed Cognition is the official Medelita blog for medical professionals interested in topics relevant to a discerning and inquisitive audience. Medelita was founded by a licensed clinician who felt strongly about the connection between focus, poise and appearance.