With the Baby Boomers now entering senior citizenhood, almost all future doctors will be, to some extent, geriatricians. It’s no wonder that discussions of end-of-life and advance care planning now figure heavily into medical education and policy discussion. Today, patients are encouraged to complete advance directives and are informed of risks, benefits and alternatives at every point in their care. Why then, do doctors themselves make such different decisions from patients in similar situations? Ken Murray, MD, an Assistant Professor of Family Medicine at USC, discusses the way that physicians approach end-of-life.
Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.