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Are Doctors More Likely To Refuse Certain Medical Care?

No CPRA must-read piece from Ken Murray:

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.

Worth the full read.

And so true. I’ve joked about getting the above tattoo when my times comes. (I would quibble that the modern CPR success rate is better than infinitesimal, especially with hypothermia, but it still ain’t great.)

It may have to do with the time I spent on the onc ward as a med student, or it may be because my mother in law is a cancer counselor, but I have the dubious distinction in our shop for being the doc most likely to make a palliative care consult and/or make a patient “comfort care only” prior to admission.

Personally, I think it’s because I am lazy, and like any other person I take the path of least resistance. Which isn’t to say that I don’t want to do the work of keeping someone alive — not at all. It’s that I find it so traumatic and horrible to subject a dying person to that sort of abuse that I’d rather face the family and have the “We need to talk” moment. It’s not less work, but it’s less awful.

I wish more ER docs took the time to do the same. I know what I want when my number is up, and I don’t want a week in the ICU on triple pressors.

*This blog post was originally published at Movin' Meat*


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