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February 26, 2012

BehindTheMedspeak: "Why Doctors Die Differently"

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How's that for a provocative headline?

It appeared over Dr. Ken Murray's essay in yesterday's Wall Street Journal.

It's well worth the time it takes to read, but in the event you can't be bothered I'll provide some excerpts below.

It's not something that we like to talk about, but doctors die, too. What's unusual about them is not how  much treatment they get compared with most Americans, but how little. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care that they could want. But they tend to go serenely and gently.

Doctors don't want to die any more than anyone else does. But they usually have talked about the limits of modern medicine with their families. They want to make sure that, when the time comes, no heroic measures are taken. During their last moments, they know, for instance, that they don't want someone breaking their ribs by performing cardiopulmonary resuscitation (which is what happens when CPR is done right).

Why such a large gap between the decisions of doctors and patients? The case of CPR is instructive. A  study by Susan Diem and others of how CPR is portrayed on TV found that it was successful in 75% of the cases and that 67% of the TV patients went home. In reality, a 2010 study of more than 95,000 cases of CPR found that only 8% of patients survived for more than one month. Of these, only about 3% could lead a mostly normal life.

Unlike previous eras, when doctors simply did what they thought was best, our system is now based on what patients choose. Physicians really try to honor their patients' wishes, but when patients ask "What would you do?," we often avoid answering. We don't want to impose our views on the vulnerable.

The result is that more people receive futile "lifesaving" care, and fewer people die at home than did, say, 60 years ago. Nursing professor Karen Kehl, in an article called "Moving Toward Peace: An Analysis of the Concept of a Good Death," ranked the attributes of a graceful death, among them: being comfortable and in control, having a sense of closure, making the most of relationships and having family involved in care. Hospitals today provide few of these qualities.

Written directives can give patients far more control over how their lives end. But while most of us accept that taxes are inescapable, death is a much harder pill to swallow, which keeps the vast majority of Americans from making proper arrangements.

There is much that could be added to Dr. Murray's observations and I will do so in a series of pieces over the upcoming days and weeks.

Let me today simply translate the numbers above regarding CPR and its real-life results.

"A 2010 study of more than 95,000 cases of CPR found that only 8% of patients survived for more than a month."

Let's stop there for a sec.

In other words, the 92% of the 95,000 patients who did not survive more than a month survived for less than a month.

Most of those did not survive the initial episode of CPR. 

But of those who did, you can be certain that none of them ever left the hospital during that month.

In other words, even if CPR was successful in restoring spontaneous heartbeat and cardiac function sufficient to maintain perfusion and blood pressure for up to 30 days, that time was spent in ICUs hooked up to all manner of monitors, intubated, on a ventilator, and for the most part with little or no spontaneous brain activity and function.

Now let's move on to the 8% of the 95,000 who did survive longer than a month.

That's 7,600 people.

"Of these, only about 3% could lead a mostly normal life."

3% of 7,600 = 228 people — out of 95,000 who received CPR.

Everyone who's not a doctor thinks they're going to be one of the 228 because they don't realize the denominator's not 228 but, rather, 95,000.

That's enough for today; some might say more than enough.

But that's your call.

[The piece as it appeared in the Wall Street Journal was adapted from an article originally published on Zócalo Public Square]

February 26, 2012 at 02:01 PM | Permalink


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Isn't it true that most people getting CPR are for all intents and purposes dead anyways? Until pronounced, you have an obligation to continue to do CPR regardless (if you are trained and know what you are doing). I mean, if you aren't a doctor, and can't do tests, and don't have access to the paddles, you don't know if they are going to survive or not, and often what kills them is the interupted CPR.

However, most likely, you are already too late to do this anyways, but who knows.

That said, the numbers are misleading; they don't tell the whole story. I have a living will in place that tells exactly what I want to be hooked up for, and I have it in the name of those that actually understand what death is...and a cold lawyer who talks about death as as opportunity (including his almost death that was in the news 5 years ago...no romantic thoughts about it other that it will eventually happen). If its just CPR...give it to me...if vents are needed...ok...if brain activity is nil...pull the plug...if I'm severely brain damaged to the point where I might survive but will be stupid...pull the plug (I've often thought of doing this for half of America anyways).

Too many people just want to end it too easily and look at the wrong stats. If I die tomorrow, I'll still know I had a great life...

Posted by: clifyt | Feb 27, 2012 11:34:02 AM

Compared to other risks that members of the public willingly take, these odds are actually pretty good! Consider the millions of participants in the various iterations of the lottery.

Posted by: MisterLee | Feb 27, 2012 11:12:02 AM

i thought this was addressed in 1415


Posted by: sherlock | Feb 27, 2012 1:58:02 AM

The statement "Of these, only about 3% could lead a mostly normal life" may well mean 3% of the original 95,000. That would be 2850 people, rather than 228. It's still bad odds.

Posted by: Michael | Feb 26, 2012 8:22:19 PM

At a point, it's all a gamble.

Posted by: JoePeach | Feb 26, 2012 7:11:22 PM

The only tattoo I've ever considered is "DNR".

Posted by: Lawlibrarian | Feb 26, 2012 4:15:47 PM

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