8mm
Posted on 08/26/2007 9:16:19 PM PDT by neverdem
NO surprises” is a basic rule in hospitals. Junior doctors are supposed to notify their superiors promptly about worrisome developments in a patient, and information is supposed to move smoothly up the chain of command. One of the gravest errors a doctor in training can make is to inform the attending physician well after the fact about a patient’s turn for the worse.
Unfortunately, this rule does not extend to seriously ill patients themselves. They and their families are frequently surprised by the sudden imminence — and the raging authority — of death.
Research has revealed doctors’ tendency to contribute to the problem by avoiding making prognoses. In one study of nearly 5,000 hospitalized adults who had roughly six months to live, only 15 percent were given clear prognoses. In a smaller study of 326 cancer patients in Chicago hospices, all of whom had about a month to live, only 37 percent of the doctors interviewed said they would share an accurate prognosis with their patients, and only if patients or their families pushed them to do so.
Even when doctors do prognosticate, the research shows, they typically overestimate the time a patient has left to live, often at least tripling it, perhaps because they feel overconfident. The pugilistic attitude most doctors adopt toward disease is understandable, even desirable, for much of the course of illness. But there comes a time when this attitude can lead to false optimism. Doctors who wrongly think that patients are going to live much longer wind up recommending needlessly painful and expensive treatments. This phenomenon is neatly captured by a gallows-humor joke told by hospice nurses: Why are coffins nailed shut? To keep doctors from administering more chemotherapy.
By not making or communicating prognoses, doctors can make the end of life more unpleasant. Patients...
(Excerpt) Read more at nytimes.com ...
Ping...
I also agree with the under medicated. Why the heck are doctors worried about addictive drugs prescribed to a terminal patient? Never mind, that last is rhetorical.
I disagree with the implied premise of the article, that MD’s overstate chances of success and expected longetivity due to a “pugilistic attitude towards disease” and “overconfidence”.
It’s much simpler than that. Most people are conflict avoiders and no one likes to give bad news. Furthermore nobody, including MD’s, wants to take away the hope and rain on the prayers of the patient and family. I know plenty of MD’s that call it straight but they don’t want to crush the spirit of the patient.
I would NOT trust a doctor to tell me how long I have to live....ever.....been misdiagnosed with stuff WAY too much.
In many other countries it is still possible, Japan for example, where death is regarded as a natural consequence of life.
We are all dying from the moment we take our first breath, but to stress that fact is definitely a no-no today.
Excellent post. If a doctor wants to kill a patient quick, he should tell him he has no hope. There are anecdotal “miracle” stories for virtually every “hopeless” medical situation.
Because of the corollary being true. Sometimes patients respond better if they think there is hope.
Candor has it exactly correct. And frankly, that's the key element causing the "healthcare crisis."
The earlier the diagnosis, the higher the cost, and the end result is always the same.
No secret. They just don't know how to do it; it may be against some 1920 law.
I have been thinking the same thing. Is there any statistical proof of this?
Yup! 100.00% of human patieints die!
Seriously, I don't have any specific data, but I am certain there are stats to prove it if a study can find the funding!
I bet you’re right. That’s why I’m skeptical of the early-detection propaganda we’ve been told. The earlier the detection, the longer we appear to live but in reality, we may not have lived one day longer—it only appears that way.
May be true for some stuff. But I -do- believe we live longer, esp for things like heart disease. Stents and bypasses absolutely do add 5-10 years of pretty productive normal lifestyle.
As for cancer treatments and such...I'm not certain that the old "natural cause" isn't better than the slow withering away via chemotherapy etc.
OTOH, at least now you've got a choice.
We’re probably pretty much on the same page. My grandmother lived for seven years after she told someone she had a lump in her breast. It was not treated. If it had been treated, it would have looked like the treatment was a success because she lived longer than the five years they use to determine successful treatment when in reality, it may not have extended her life one day. I don’t know.
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