Tuesday, January 19, 2016

We're Here to Help

I do still look up health news now and again, considering topics of interest. And, this evening I ran across this story from ABC News.

The headline captures the point well: “Many Doctors Choose End-of-Life Care Differently Than the General Population, Two Studies Show.” In fact the two studies appeared today in JAMA. the Journal of the American Medical Association. You can review them here and here. The points are that doctors are less likely than the general public to die in a hospital, or to use medical procedures and technology at the end of life. Both studies are based on the medical records of literally hundreds of thousands of people, and as we all know, those large numbers mean statistically meaningful results.

Perhaps this would be a surprise to someone, but not to those of us who work in healthcare. Indeed, the second study looked at folks who worked in healthcare who were not doctors; and their results were closer to the doctors than to the general public. The comment in the article is that the general public isn’t prepared to discuss what the limits might be to appropriate care. I think we need to respect the other side of that coin: those of us who work with it every day are more likely to discuss it, precisely because we have seen what those hospital stays and late life interventions do – and don’t -  accomplish.

I don’t want to press these results too far. While the differences are statistically significant, they aren’t absolute. In fact, a lot of those late life interventions in hospitals happen before the decision is reached that it is in fact the end of life. And, of course, there are certainly enough doctors who also have difficulty talking about decisions at the end of life – their own lives and those of their patients.

At the same time, perhaps the opportunity is for folks who don’t work in healthcare to ask those of us who do, whether doctors or not. It would be even better if they were to ask us especially when it isn’t a crisis. I have said often enough that these topics should be discussed over breakfast at home; and that the worst place to discuss the patient’s wishes is at a bedside in ICU at 2:00 in the morning.

So, perhaps the ABC News article can stimulate more of these conversations. It is a bit easier to have these conversations with one’s physician these days, but you don’t have to wait for that annual appointment. Perhaps it would be better to have the conversation with friends and family, especially (but not limited to) any who work in healthcare. We know the stakes. We want to help. And if it does get to 2:00 in the morning at a bedside in ICU, it’s likely to be those family and friends who get asked just what your values would be.

No comments: