DISQUS

Cranky Kong,MD · 7 months ago

Maybe sometimes it has to do with the patient's relationship with his or her Primary physician? My first job out of fellowhip was with an older MD on the verge of retirement. He'd been in practice in the same town for 30 years and his patients had grown old with him. most of them had had at some point the big DNR conversation with him. Most of them had reasonable expectations and quite a few of them died peacefully in their sleep ( we would get the phone calls from the M.E.) I guess he was a relic of the time when doctors could actually sit down with a patient for more than the alloted 10 or 15 minutes.

When i once wanted to fully anticoagulate, beta block and digitalize a 98 year old patient of his whose lone medical illness was A fib, he gently took me aside and told me that my job was to make her feel better, not kill her. I do believe she lived to be 100 years old, and only took an aspirin a day.

Bo... · 7 months ago

I think it depends on the person's fear (or lack of fear) of the idea of death. And then there's also people who might be labeled "control freaks" who cannot abide the thought of being a vegetable, and so they opt for comfort measures only. And then there are those who are totally suspicious of the medical community in general, and are afraid of being erroneously under-treated (leading to death) or of being erroneous over-treated (leading to the doctor acquiring a Mercedes Benz...)

Anonymous · 7 months ago

These are all good theories, and I suspect Cranky's answer is closest to the truth. But I find that, generally. It has to do with socio-economic status and education. As a general Rule which I shall call the Hospitalist Equation of Inpatient Economics:

"The less a person has contributed to society by the time of death, the more will be demanded be done to prolong their life."

i.e: Welfare/medicaid patients and their families demand millions of dollars of care, more educated patients understand death is a part of life, and is natural. This is especially true for hospital employees/physicians. Sad. I heard a ridiculous statistic that 90% of the money a person spends on lifetime healthcare is done in the last 6 months of life. Free=More

Anonymous · 7 months ago

Religion's Impact on End-of-Life Care

Patients Who Rely on Religion to Cope Are More Likely to Have Aggressive Medical Care

Terminally ill cancer patients who relied on their religious faith to help them cope with their disease were more likely to receive aggressive medical care during their last week of life, a study shows.

Patients who engaged in what the researchers called positive religious coping, which included prayer, meditation, and religious study, ended up having more intensive life-prolonging interventions such as mechanical ventilation or cardiopulmonary resuscitation.

The study is published in the latest edition of The Journal of the American Medical Association.

http://thehappyhospitalist.blogspot.com/2009/05/how-do-patients-think.html#comments

Anonymous · 7 months ago

Oops. Meant to post this link, not yours:

http://www.webmd.com/cancer/news/20090317/religions-impact-on-end-of-life-care?src=RSS_PUBLIC