How doctors die, cont’d.

By Sarah Kliff,

Retired physician Ken Murray got a lot of attention last month with his essay “How Doctors Die,” which suggested that physicians are more adverse to “futile care” delivered near the end of life than the rest of us.

“I cannot count the number of times fellow physicians have told me, in words that vary only slightly, ‘Promise me if you find me like this that you’ll kill me,’” he wrote. “Some medical personnel wear medallions stamped ‘NO CODE’ to tell physicians not to perform CPR on them.” But as Ezra noted at the time, Murray’s evidence was largely anecdotal. Shannon Brownlee’s evidence, however, is not:

There is good evidence that physicians have thought out end-of-life issues more thoroughly than lay people and are more likely to decline medical intervention. For example, they sign advance directives far more often than the rest of us do. Less than half of severely or terminally ill patients have an advance directive in their medical records. These are legal documents that indicate the kind of medical care we prefer at the end of life and where we would like to spend our last few days or weeks. Contrast that to a study published a few years back that found 64% of doctors surveyed had signed such documents. Those who had were nearly three and a half times more likely to refuse rescue care, like CPR, compared with doctors who had not signed an advance directive.

Why would doctors be so anxious to avoid the very procedures they deliver to their patients every day? For one thing, they know firsthand that these procedures are most often futile when performed on a frail, elderly, chronically ill person. Only about 8% of people who go into cardiac arrest outside of the hospital are revived by CPR. Even when your heart stops in the hospital, you have only a 19% chance of surviving. That’s a far cry from the way these procedures are portrayed on TV, where practically everybody survives having his heart shocked and undergoing CPR.