How Doctors Choose to Die

How Doctors Choose to Die

A recent Sermo Physician Poll  of nearly 2,000 doctors asked, “if faced with a terminal illness, what treatment options would you choose?” Of those responding: ♦ Palliative care 55% ♦ Hospice care 43% ♦ DNR 39% ♦ Unsure 16% ♦ Extraordinary measures 7% The findings from Sermo, the number one social network exclusively for physicians, are consistent with other surveys over the years, including a study recently published in PLOS ONE, which highlighted a “disconnect” between what physicians say they would want for themselves and what they actual provide to their patients. The PLOS ONE study also looked at physician’s attitudes toward advanced directives (ADs), comparing a cohort of 2013 doctors to a 1989 cohort (one year before the Patient Self Determination Act in 1990). The survey of more than 1,000 doctors found that 88% would choose a “no code” or “do-not-resuscitate” order for themselves. When it came to attitudes toward ADs, compared to 1989, 2013 cohort did not feel that widespread acceptance of AD would result in less aggressive treatment even of patients who do not have an AD; had greater confidence in their treatment decisions if guided by an AD; and were less worried about legal consequences of limiting treatment when following an AD. However, other than those 3 items, there were no significant differences in the doctors’ attitudes across the 1989 and 2013 cohorts in the other 11 of 14 items in the AD attitude survey—including that the overwhelming majority of physicians in both cohorts felt that prolonging life is more important than honoring a patient’s request to withhold treatment. In an article, How doctors die...

Guidelines Update: Managing Spontaneous Intracerebral Hemorrhage

Intracerebral hemorrhage (ICH) has long been recognized as one of the most severe forms of stroke. According to the American Heart Association (AHA), ICH accounts for less than 10% of first-ever strokes, but is more likely to result in death or major disability. Studies have estimated that 35% to 52% of patients with ICH die within a month. More than 60,000 patients in the United States have an ICH in a year, but only about 20% of these individuals are expected to be functionally independent 6 months after their event. The AHA and American Stroke Association (ASA) published an updated evidenced-based guideline in the September 2010 issue of Stroke to inform physicians on the most current and comprehensive recommendations for the diagnosis and treatment of acute spontaneous ICH. The guideline covers diagnosis, hemostasis, blood pressure management, inpatient and nursing management, prevention of medical comorbidities, surgical treatment, prognosis, rehabilitation, prevention of recurrence, and other considerations. The authors incorporated new clinical trial results and multiple updates since the last guidelines were published in 2007 (Table). “Aggressive, critical care by physicians to treat patients presenting with ICH is likely to improve outcomes.” “The underlying message of the AHA/ASA guideline update is that ICH is a very treatable disorder, and the overall aggressiveness of ICH care is directly related to mortality from this disease,” says Lewis B. Morgenstern, MD, FAHA, FAAN, who chaired the committee that created the guideline update. “As a medical community, we tend to be too nihilistic in our treatment of ICH. Even though there is currently no ‘magic bullet’ to treat the disease, the nihilism has led to poor outcomes. Aggressive, critical care by...