Doctoring Reflection

Going gently…

…is how doctors die.

Few essays written by doctors are more relevant to today’s crisis in end of life care than Dr Ken Murray’s now famous, Why Doctors Die Differently.  It made it to the WSJ today, thank goodness. It’s available for free in its original (and longer) form at Zocala Public Square.

We discussed two cases this week in a review committee. Both patients were elderly and had multiple organs failing, but both underwent aggressive procedures that failed to prevent death. The debate centered on why the bad outcomes had occurred. I suggested that maybe the procedures should not have been done in the first place. Blank faces appeared. One person muttered, “they would have died.” But they died anyways, with a lot of tubes, bright lights and pain.

Dr Murray has it right…

Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits.

Knowing our limits. That’s a tough one. My greatest challenge as a doctor in 2012 is not moving catheters, or sliding leads through s-shaped veins; these are easy, compared to honing the skills needed to help patients decide whether they should, or should not have such fury done onto them.


4 replies on “Going gently…”

It was always thus ! There is a saying that a good surgeon knows when to operate and a wise one, when not to operate. I am a cardiac surgeon and it took me several years as a Consultant (similar to attending in UK system) before I felt I had gained the skill and wisdom – A good reason for Heart teams or more collaborative working with individuals of different experiences.

My greatest fear after spending 30 of my last 40 working years in critical care arenas, is waking up in one on a vent. I grew older in this field I found my inner peace had moved from from saving lives, to helping families prepare and deal with their pending loss.

I am an administrator for a hospice that I recently started for an investor in Scottsdale Arizona. I am putting together a specialized program for caring for end stage cardiac patients. In the past I have developed programs for the end stage Alzheimer patient that have been very successful for the patient and caregivers. I am interested in receiving input from Cardiologists as to what they (you) would like to see in a hospice program for your end stage cardiac patients.
I will say that in all my years (around 8) practicing hospice I can remember only one physician that was actually referred to hospice. I have cared for many nurses however. Any input or advice will be welcomed. I have a real love for hospice and believe that patients need to be treated as individuals with regard not only to culture and beliefs but with regard for the specific disease they have. All hospice patients are very different and in my hospice those differences will be taken into account when care planning.

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