Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Overtreatment and the ethics of end of life care

Bradley Flansbaum, DO
Physician
March 1, 2012
Share
Tweet
Share

There was an exceptionally well-written piece published in the Washington Post recently.  I presume a hospitalist wrote it, which magnifies its significance.  In it, he describes the difficulties in caring for terminally ill patients.

As I read it, it reminded me of a story my dad told me several years ago.  His friend, I will call him Steve, was experiencing a great deal of stress because of his dad’s ailing health.  You see, his father had end stage dementia.

Steve relayed that his dad specifically communicated to him years earlier that he never wanted to experience the kind of death his father, Steve’s grandfather, underwent.  This, the heart wrenching and protracted death we all know on the wards: stepwise cognitive decline, erosion of ADL’s, and ultimately custodial dependence.  The patient is a shell of their former selves unable to interact or recognize family.

The irony and sadness was, Steve watched this same misfortune play out with his own dad.  Why you ask?  Because it happened so gradually, and so subtly, that there was no epiphanic moment to act on and deter.

I can only speak for men, but the idealized demise at 85—a round of golf, a fine meal, making love to the woman you love—and a painless death as you drift deeply to sleep—is a fools game.  Other than the errant politician, we have more fingers on one hand than accounts of that sort of celestial departure.  Steve’s experience is more commonplace, and it occurs that way just because.  It is life.

Overlay that anecdote with an encounter I had earlier this month.  I was with my resident team, on the wards, discussing another physician’s terminally ill patient.  As I began to deliberate on overtreatment and the ethics of end of life care, a radiation oncologist with whom I have a superficial, but cordial relationship joined in the discussion.  As he engaged, sentences such as “families need to know,” and “society must come to grips with our healthcare problem,” riddled his commentary.  It was the familiar, “America must have an adult conversation” oration.  The irony was, and this makes it so tragic, his patient was our focus.  His close proximity to the patient’s course, and long-term relationship with our subject blinded him. The irony was overpowering, and it gave us all pause.  Silence was the best tutorial of all.

Most of us, even the most experienced, believe we can navigate and identify points A to D.  We cannot.  The practice of medicine is A to B to C to D.  There is no instruction manual to render the spaces.

Next time you illustrate the dysfunctions of our system in a pedagogic role, ponder the above scenario.  Why? It might be you the team across the hall is discussing.

That is why resolving this problem is so damn hard.

Bradley Flansbaum is Director, Hospitalist Services at Lenox Hill Hospital in New York City. He blogs at The Hospitalist Leader.

Submit a guest post and be heard on social media’s leading physician voice.

Prev

A sick care system instead of a health care system

March 1, 2012 Kevin 8
…
Next

How a birth control medication recall can lead to high drug costs

March 1, 2012 Kevin 1
…

Tagged as: Hospital-Based Medicine, Palliative Care

Post navigation

< Previous Post
A sick care system instead of a health care system
Next Post >
How a birth control medication recall can lead to high drug costs

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Bradley Flansbaum, DO

  • Are safe harbors the answer to medical malpractice?

    Bradley Flansbaum, DO
  • a desk with keyboard and ipad with the kevinmd logo

    The problem with round the clock hospitalist coverage

    Bradley Flansbaum, DO
  • a desk with keyboard and ipad with the kevinmd logo

    Calling yourself Doctor and what that now means

    Bradley Flansbaum, DO

More in Physician

  • Ethical dilemmas in using unclaimed bodies for medical research

    M. Bennet Broner, PhD
  • The Nova Oath: a physician’s pledge to courageous and ethical care

    Kenneth Ro, MD
  • True stories of doctors reclaiming their humanity in a system that challenges it

    Alae Kawam, DO & Kim Downey, PT & Nicole Solomos, DO
  • Why wanting more from your medical career is a sign of strength

    Maureen Gibbons, MD
  • How a rainy walk helped an oncologist rediscover joy and bravery

    Dr. Damane Zehra
  • How inspiration and family stories shape our most meaningful moments

    Arthur Lazarus, MD, MBA
  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • First impressions happen online—not in your exam room

      Sara Meyer | Social media
    • How to speak the language of leadership to improve doctor wellness [PODCAST]

      The Podcast by KevinMD | Podcast
    • Dedicated hypermobility clinics can transform patient care

      Katharina Schwan, MPH | Conditions
    • Why ADHD in adults is often missed—and why it matters [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
  • Recent Posts

    • How to speak the language of leadership to improve doctor wellness [PODCAST]

      The Podcast by KevinMD | Podcast
    • Ethical dilemmas in using unclaimed bodies for medical research

      M. Bennet Broner, PhD | Physician
    • The Nova Oath: a physician’s pledge to courageous and ethical care

      Kenneth Ro, MD | Physician
    • AI is not a threat to radiologists. It’s a distraction from what truly matters in medicine.

      Fardad Behzadi, MD | Tech
    • How deep transcranial magnetic stimulation is transforming mental health care

      Muhamad Aly Rifai, MD | Conditions
    • True stories of doctors reclaiming their humanity in a system that challenges it

      Alae Kawam, DO & Kim Downey, PT & Nicole Solomos, DO | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 10 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • First impressions happen online—not in your exam room

      Sara Meyer | Social media
    • How to speak the language of leadership to improve doctor wellness [PODCAST]

      The Podcast by KevinMD | Podcast
    • Dedicated hypermobility clinics can transform patient care

      Katharina Schwan, MPH | Conditions
    • Why ADHD in adults is often missed—and why it matters [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
  • Recent Posts

    • How to speak the language of leadership to improve doctor wellness [PODCAST]

      The Podcast by KevinMD | Podcast
    • Ethical dilemmas in using unclaimed bodies for medical research

      M. Bennet Broner, PhD | Physician
    • The Nova Oath: a physician’s pledge to courageous and ethical care

      Kenneth Ro, MD | Physician
    • AI is not a threat to radiologists. It’s a distraction from what truly matters in medicine.

      Fardad Behzadi, MD | Tech
    • How deep transcranial magnetic stimulation is transforming mental health care

      Muhamad Aly Rifai, MD | Conditions
    • True stories of doctors reclaiming their humanity in a system that challenges it

      Alae Kawam, DO & Kim Downey, PT & Nicole Solomos, DO | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Overtreatment and the ethics of end of life care
10 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...