A recent interview on NPR, “Knowing How Doctors Die Can Change End-of-Life Discussions”, discussed the finding that 88% of doctors, if they had a terminal illness, do not want CPR or aggressive treatments—the opposite of how they usually treat their patients!
Dr. Ken Murray described this in 2011 [How Doctors Die]; and it was confirmed with a survey of physician attitudes by Dr. V.J. Periyakoil at Stanford University: a) doctors don’t practice what they preach, b) their attitudes regarding advance directives for their patients haven’t changed in 25 years, and c) they reject CPR for themselves.
Dr. Periyakoil explains it’s not just because they want to make more money or are insensitive to patients wishes; rather, they are taught to prolong life at whatever cost within a system that pays them for ‘doing more’, but doesn’t reward talking to patients.
You would think that ‘communication’ should be an essential component of doctor education; unfortunately, they aren’t trained so that what they say is easily understood. And, doctors admit they are uncomfortable when having end-of-life [EOL] discussions.
Other reasons for this communication ‘disconnect’ include: marketing has convinced the public (and doctors) that tests identify things the doctor may miss (even though no other treatment would be done), and so patients expect ‘tests’; and physicians fear being sued if they ‘miss something’ (it’s estimated that 35% of all tests are done for this reason).
Medicare will start paying physicians in 2016 if they talk with patients about EOL issues. Hopefully, this will improve a patient’s quality of life with fewer futile interventions. But, families/patients still need to be assertive about asking if a test or drug would really be beneficial—and what would the doctor do in their shoes!