Physicians Less Likely to Die as Patients in the Hospital than Other Patients

As a rule of thumb and when asked a difficult question by a physician about how to proceed with some important aspect of your care, one response might be to ask how he or she would respond to the same question. With this in mind, I found it revealing to learn that recent research has shown that physicians are less likely to die in the hospital that other comparable patients (see: Physicians Less Likely to Die in Hospital Than Other Patients). Below is an excerpt from the article:

Disparities in end-of-life care between physicians and the general patient population suggest a gap between what physicians choose for themselves and the care provided to most patients. New research examining the intensity of end-of-life care and the locations of death for physicians and nonphysicians indicate that physicians receive less aggressive care before death. They are also less likely to die in the hospital and are more likely to receive hospice care than similar nonphysical patients. The findings...may add credence to the view expressed by some experts that physicians die in a manner that is more consistent with their end-of-life preferences than does the general population....Compared with lawyers, who are considered socioeconomically and educationally similar, physicians were significantly less likely to die in a hospital....Physicians and lawyers did not differ, however, on other measures of care....[Study authors noted] that physicians' insight into the "burdens and futility" of intense end-of-life care, "as well as the benefits and the financial resources to pay for other treatment options" may partially explain the difference. That only one measure differed between physicians and lawyers (the likelihood of in-hospital death) suggests that "actual experience with hospital deaths may differentially motivate physicians to avoid them," the authors hypothesize.

I have posted a number of previous notes about end-of-life and hospice care (see: Aggressive Care, Not Palliative Care, the Norm in New York Academic Hospitals; Impressive Growth in Hospital-Based Palliative Care Teams; Potential Cost Savings Associated with Palliative Care Teams in Hospitals; End-of-Lilfe Palliative Chemotherapy Not Always Appropriate). For me, the most goal stated in this article regarding end-of-life care was the following: [the desire to avoid the] "burdens and futility" of intense end-of-life care.

I think that it's incumbent on physicians to provide patients and family members with a realistic assessment about the value and expense of protracted end-of-life care for a patient. These are not easy conversations for all concerned. Some physicians are not able to easily provide the best advice in such a setting and some patients and their relatives are not prepared to accept unfavorable news. Nevertheless, the article cited above suggests that physicians in an end-of-life situation (as well as the the physicians caring for them) tend to opt for a "lightening" of the burdens and futility of end-of-life care and to discharge "physician patients" to home at the end of life. We should all take note.