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

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

  • Physician work-life balance and family

    Francisco M. Torres, MD
  • Love and loss in the oncology ward

    Dr. Damane Zehra
  • The weight of genetic testing in a family

    Rebecca Thompson, MD
  • A surgeon’s view on RVUs and moral injury

    Rene Loyola, MD
  • Reclaiming moral ambition in health care

    Mick Connors, MD
  • When language barriers become a medical emergency

    Monzur Morshed, MD and Kaysan Morshed
  • Most Popular

  • Past Week

    • A doctor’s letter from a federal prison

      L. Joseph Parker, MD | Physician
    • When language barriers become a medical emergency

      Monzur Morshed, MD and Kaysan Morshed | Physician
    • A surgeon’s view on RVUs and moral injury

      Rene Loyola, MD | Physician
    • Why doctors are losing the health care culture war

      Rusha Modi, MD, MPH | Policy
    • The hypocrisy of insurance referral mandates

      Ryan Nadelson, MD | Physician
    • A cancer doctor’s warning about the future of medicine

      Banu Symington, MD | Physician
  • Past 6 Months

    • Rethinking the JUPITER trial and statin safety

      Larry Kaskel, MD | Conditions
    • The ignored clinical trials on statins and mortality

      Larry Kaskel, MD | Conditions
    • How one physician redesigned her practice to find joy in primary care again [PODCAST]

      The Podcast by KevinMD | Podcast
    • I passed my medical boards at 63. And no, I was not having a midlife crisis.

      Rajeev Khanna, MD | Physician
    • Why doctors must fight for a just health care system

      Alankrita Olson, MD, MPH & Ashley Duhon, MD & Toby Terwilliger, MD | Policy
    • The silent disease causing 400 amputations daily

      Xzabia Caliste, MD | Conditions
  • Recent Posts

    • How AI on social media fuels body dysmorphia

      STRIPED, Harvard T.H. Chan School of Public Health | Policy
    • Physician work-life balance and family

      Francisco M. Torres, MD | Physician
    • Why hesitation over the HPV vaccine threatens public health and equity

      Ayesha Khan | Conditions
    • What psychiatry teaches us about professionalism, loss, and becoming human

      Hannah Wulk | Education
    • How Gen Z is reshaping health care through DIY approaches and digital tools [PODCAST]

      The Podcast by KevinMD | Podcast
    • Love and loss in the oncology ward

      Dr. Damane Zehra | 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

  • Most Popular

  • Past Week

    • A doctor’s letter from a federal prison

      L. Joseph Parker, MD | Physician
    • When language barriers become a medical emergency

      Monzur Morshed, MD and Kaysan Morshed | Physician
    • A surgeon’s view on RVUs and moral injury

      Rene Loyola, MD | Physician
    • Why doctors are losing the health care culture war

      Rusha Modi, MD, MPH | Policy
    • The hypocrisy of insurance referral mandates

      Ryan Nadelson, MD | Physician
    • A cancer doctor’s warning about the future of medicine

      Banu Symington, MD | Physician
  • Past 6 Months

    • Rethinking the JUPITER trial and statin safety

      Larry Kaskel, MD | Conditions
    • The ignored clinical trials on statins and mortality

      Larry Kaskel, MD | Conditions
    • How one physician redesigned her practice to find joy in primary care again [PODCAST]

      The Podcast by KevinMD | Podcast
    • I passed my medical boards at 63. And no, I was not having a midlife crisis.

      Rajeev Khanna, MD | Physician
    • Why doctors must fight for a just health care system

      Alankrita Olson, MD, MPH & Ashley Duhon, MD & Toby Terwilliger, MD | Policy
    • The silent disease causing 400 amputations daily

      Xzabia Caliste, MD | Conditions
  • Recent Posts

    • How AI on social media fuels body dysmorphia

      STRIPED, Harvard T.H. Chan School of Public Health | Policy
    • Physician work-life balance and family

      Francisco M. Torres, MD | Physician
    • Why hesitation over the HPV vaccine threatens public health and equity

      Ayesha Khan | Conditions
    • What psychiatry teaches us about professionalism, loss, and becoming human

      Hannah Wulk | Education
    • How Gen Z is reshaping health care through DIY approaches and digital tools [PODCAST]

      The Podcast by KevinMD | Podcast
    • Love and loss in the oncology ward

      Dr. Damane Zehra | 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...