Do doctors die better than other people?
A few years ago, a compelling essay written by a retired US doctor went viral. In the essay, Dr Ken Murray explored how doctors navigate the business of their own death. He wrote about a colleague who had discovered discovered a lump in his stomach, the diagnosis of which turned out to be pancreatic cancer. Surgery could increase his poor odds of survival, from 5% to 15%, but the colleague wasn’t interested – he knew only too well how brutal the treatment was and what poor quality of life it led to. Despite the fact that he would in all probability recommend such treatment to a patient, he declined it himself.
Doctors, the author posited, die differently from their patients. When push comes to shove, they want fewer treatments, rather than more. They value quality of life over a few extra weeks or months, or even a longshot chance of a cure. They treat their patients one way, and yet they do it themselves in a different way.
But is it true? What’s certainly right is that almost all doctors have an experience of being involved in giving futile care to a patient. And that, in turn, impacts how they think they want to be treated themselves at the end of their life. Performing CPR – which has a very low chance of success, can result in broken ribs, and all in all seems a pretty unpleasant way to end one’s days – seems to have a particular effect on the way doctors envisage their own end of life. One recent study of over 1,000 doctors showed that almost 90% would not wish to be resuscitated if terminally ill. Another study surveyed both doctors and their patients as to what kind of end-of-life care they would prefer. Doctors opted for less treatment than their patients in almost all cases. They were also more likely than the general public to have drawn up an advance directive that lays out care plans in the event that the patient is unable to make decisions.
But do doctors’ previously stated wishes correlate with what actually happens to them at the end of their life? Two studies give slightly different responses, but the answer seems to be mostly ‘no’. A 2016 retrospective study published in JAMA, which looked at where nearly 500,000 people died, found that physicians were only slightly less likely to die in a medical facility than the general population, despite the surveys showing that the vast majority of people – doctors included – would prefer to die at home. Another study found similar hospitalisation rates among doctors and the general population at the end of life, although doctors were a little more likely to opt for hospice care.
The final question to ask seems to be why doctors get roughly the same treatment at the end of life as everyone else, despite their stated preferences. Dr Daniel Matlock, co-author of the study on doctor hospitalisation rates, says the problem is that the odds may be stacked against patients getting the end-of-life care they want, even if the patient is a doctor. Once you find yourself locked into the medical system, it can be almost impossible to extricate yourself from it, particularly when you are already frail and ill.
“These things that encourage low-value care at the end of life are big systems issues,” says Dr Matlock. “And a strong, informed patient who knows the risks and benefits – maybe even they have a hard time stopping the train.”
A caveat is that all the aforementioned studies were carried out in the US, where end-of-life treatment tends to be more aggressive than in Australia and futile treatment more common. Unfortunately, no studies of this kind have been carried out in Australian populations.