The End-Of-Life Habits Of Medical Professionals, And Whether They Really Choose To Stay Out Of The Hospital

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Do doctors choose comfort-based care over hospital stays? Pixabay Public Domain

Doctors can seem larger than life for those with no medical knowledge, but they face the same ailments as everyone else. Though they cannot escape the illnesses that cause death, doctors have firsthand hospital experience that could lead them to deal with the end of their lives differently than most. A group of researchers was curious if this was the case — do doctors choose less high-intensity, hospital-based care than other people as they approach death? According to the study’s results, not really.

The researchers examined Medicare records from 9,947 physicians who had passed away and compared them to 191,426 deceased nondoctors. While previous surveys have suggested that the public believes doctors would spend fewer days in hospital care at the end of life, the new findings did not support the idea.

The team saw that doctors spend about the same amount of time in the hospital during their last six months as nondoctors, and that the proportion of both groups that had at least one stay in an intensive care unit was around the same as well. In fact, doctors spent slightly more days in the ICU than nondoctors during both the last six months and last one month of their lives. They were also more likely to enroll in hospice care for some time during their final months.

The researchers suggested that fear of dying and the desire to avoid it are fundamental human motivators, and doctors are not immune to such feelings. This thinking stands in contrast to past essays and surveys on doctors in the end of life. One 2011 essay, by Dr. Ken Murray, detailed the decision one doctor made to opt into comfort-based care rather than chemotherapy for an incurable cancer. Doctors themselves even believe they die differently than others.

“When physicians are surveyed, they overwhelmingly opt for a nonaggressive, comfort-based approach to care in the face of life-limiting illness,” the researchers wrote in their report. “Physicians are also more likely to have completed an advance directive documenting care preferences than the general population.”

The authors also note that doctors’ knowledge of healthcare puts them in a better position to understand prognosis and the potential costs and benefits of a medical technique and to make informed decisions based on that knowledge.

Concern over end-of-life care has grown among the public, doctors, and policymakers, say the researchers, and the main issues include cost and access to care. Some have voiced concerns that many interventions provided at the end of life may be of little or no value. Indeed, higher spending in the last week of life has been associated with poorer quality of death. Also, the researchers note, “many interventions may be discordant with the individual’s preferences.”

Matlock D, Yamashita T, Min S, Smith A, Kelley A, Fischer S. How U.S. Doctors Die: A Cohort Study of Healthcare Use at the End of Life. Journal of the American Geriatrics Society. 2016.

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