Doctoring General Cardiology Hospice/Palliative Care ICD/Pacemaker

Avoiding a bad death requires preparation

If there was a hashtag for sub-specialty healthcare and ICU medicine in the United States it would be:


A recent study led by Dr. Harlan Krumholz (Yale University) showed that we have become more efficient at keeping elders alive. This is not surprising. And it’s good news in the sense that technology–if used wisely–can enhance both quality and quantity of life.

The key phrase above is…if used wisely.

The obvious fact remains: Human beings don’t live forever. The same medical technology that can extend life can also prolong death. Most cases we review each month in our peer-review meeting begin with an elderly or chronically ill person who suffered excessive care at the end of life. This happens because the default in hospitals is to do everything.

Life-prolonging care in 2015 is aggressive, often painful, and doctor-centric. Life-prolonging care steals autonomy and shuns dignity. Life-prolonging care is immense.

The key to avoiding a bad death is preparation. To prepare is to make something ready for consideration; create in advance; have a plan. Dr. Dan Matlock (University of Colorado) and I wrote that doctors, electrophysiologists particularly, should help their ICD patients make plans for turning off shocks when death is near. Dr. Jeffrey Burns (University of Pennsylvania) urged kidney doctors to help dialysis patients plan for the future–and avoid futile CPR. Dr. Atul Gawande educates the entire world with his best-selling book, Being Mortal.

Then there is ZDoggMD, who spreads common sense in his unique way:

To make ready. This is the key.


3 replies on “Avoiding a bad death requires preparation”

Right on the money! Patients need to be out front of this as well!
If you live in a state that offers a POLST….get it and get your doc on board with it!

Thank you for this article and, in particular, addressing ICD and Dialysis patients. As a non healthcare professional, now immersed in ‘knowledge mobilization’ for fellow patients, it’s these two examples I present to illustrate the kind of issues in addition to (and well before) DNR. I feel fortunate to have had a conversation with (retired ) nephrologist and fellow tweeter @RobertAllanBear ) for my consumer-facing website.
I will link to this article, too!

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