In recent years, it has become conventional wisdom that physicians avoid the end-of-life mistakes that many of the rest of us make. The story: They die at home rather than in hospital intensive care units. And they rely on comfort care such as hospice or palliative care rather than often-futile high tech medicine.
That conventional wisdom, it turns out, is a myth—at least according to a new study by Daniel Matlock and colleagues published in the Journal of the American Geriatrics Society. Docs, despite their better understanding of the nature of terminal illness, their knowledge of the limitations of medical treatment at the end of life, and even their ability to talk as peers to their own physicians, die pretty much like the rest of us.
They are as likely to be hospitalized at the end of life. They are as likely to have a stay in an intensive care unit, and to spend as many days overall in the hospital as non-docs. They are just as likely to die in the hospital. In the only real difference, they are slightly more likely to use hospice care, and for a bit longer, than non-physicians.
In general, though, their experience is the same as the rest of us. Interestingly enough, there is some variation among medical specialties. For instance, psychiatrists are least likely to use hospice, while pathologists are most likely.
The researchers reviewed claims data for the last six months of life for about 10,000 physicians and a random sample of 192,000 Medicare beneficiaries who died between 2008 and 2010. While they tell an important story about what happens to doctors at the end of life, they can only speculate about why.
One possible reason: Once you find yourself in the vortex of the medical system, and especially once you are hospitalized, it is almost impossible to extricate yourself. There is always one more test to take, one more treatment to try. The fee-for-service Medicare payment system and the unwillingness of attending physicians to “give up” are a powerful incentive for providers to offer more treatment. And when doctors recommend, patients accept. Even patients who are themselves physicians are unable to resist that powerful gravitational pull.
My hospice chaplain wife has another theory. She believes that for some docs at the end of life, it is all about control. To them, accepting hospice—and death—means ceding the battle to their disease. And while that is hard for many of us, it may be especially difficult for docs. After all, most spent their careers fighting disease.
The authors also speculate that younger generations of doctors may approach their own medical treatment at the end of life differently than the generation of physicians in this study, who had an average age at death of nearly 83. They note, of course, that they won’t know for sure for 30 years.
Whatever the reasons, this study finds that a “good death,” or at least one without high-tech– but fruitless– interventions in an ICU, is no easier for physicians than for the rest of us. You may find that comforting. Or you may find it very sad.
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