
How Doctors Die (2011) - nkurz
http://www.zocalopublicsquare.org/2011/11/30/how-doctors-die/ideas/nexus/
======
ben1040
HN Commentary from 2011: <https://news.ycombinator.com/item?id=3313570>

~~~
pitiburi
The OP posted on that thread, so he knew this was a repost. Interesting
article, but i fear for HN if reposting an old and interesting link you
remember becomes a way of getting easy karma.

~~~
ChuckMcM
I suppose if the goal was karma farming then to be complete you would first
repost a highly ranked story and then you would repost the highest ranked
comment on your repost. And presumably if the same people read it again and
voted again then you would capture the most possible re-karma points :-)

~~~
djt
Luckily karma doesn't mean anything :D

~~~
Rinum
Does it not? I thought higher karma results in your submissions and comments
being ranked higher/viewed more.

------
javert
As a 26 year old American, my experiences with the US hospital system have
been so abysmal that I would consider not even seeking treatment for many
serious conditions unless I knew the solution would be straightforward.

Abysmal in terms of having good medical outcomes, and being treated
respectfully by hospital staff (who tend to be extremely overworked).

Plus, it's degrading to have no control over how much you will be charged, and
whether insurance will cover it.

I personally have had one relatively minor medical issue, so the above comes
more from experiences with family members in the hospital.

~~~
purplelobster
I wonder how much stress over money affects the health of patients. It's just
the last thing you want to worry about when your body is failing.

I also think the system puts too much stress on relatives and the patient when
it comes to choices and bureaucracy. Coming from Sweden, just having to choose
between 7-8 different insurance plans is headache enough, but to have to
choose your doctor, your hospital etc is just too much. I don't want to have
to think about it. Americans seem to value choice and being able to shop
around much more highly than I do. "Being a good consumer". I can
intellectually understand why, but making choices all the time for everything
is very taxing and energy consuming, and at some point I just want to be taken
care of.

~~~
philwelch
What happens in Sweden? Does the state assign a doctor to you? What happens if
you don't like that doctor and want a different one?

I wouldn't want to do away with the freedom of choice, convenient as it may be
to have a default. Besides, once you've chosen all those things you can just
stick with them for years on end.

~~~
purplelobster
I'm sure you can choose if you really really want to, but there are sensible
default options. The way it should be in my opinion: 1\. Go to nearest
hospital, no need to worry about insurance or whether it's a "preferred"
hospital for your insurance company. 2\. Get assigned doctor(s) based on your
needs. 3\. Get treatment. No need to check what treatments are covered and if
your doctor is trying to screw you over with unnecessary expensive tests. 3\.
Relax. No paperwork because there is a unified information system. No
insurance paperwork because it's all covered.

I think it's difficult to imagine how much easier it can be, when you're used
to dealing with heavy bureaucracy and insurance companies. I can't explain how
much less stressed I was in that system. Then again, I'm even stressed about
owning a car with all that entails in terms of check-ups, oil changes,
repairs, insurance, expiring licenses, parking etc. Perhaps other people are
better at dealing with this crap than I am.

~~~
philwelch
For regular doctor's appointments, I don't go to the hospital, I just go to my
doctor's office.

I can imagine pretty well. When things are set up with _good_ insurance
coverage, it's hardly any different than what you described, maybe with the
exception of preferred networks, but in my city I've never had any doctor fall
outside of the preferred network for my insurance anyway. Everything is either
covered from the insurance or you get a straightforward bill, and even then
you can get an HSA to cover your out-of-pocket expenses with some insurance
plans. I've never had to deal with insurance paperwork either, aside from
collecting my insurance card from the mail and presenting it at the doctor's
office. It can easily be much, much worse though.

~~~
purplelobster
Well, obviously there are exceptions, but I wouldn't measure or defend a
system based on the best case, but the average and standard deviation.
Unfortunately, a huge amount of people are falling through the cracks.
Sweden's system might be worse for rich/upper middle class people, but the
average case is more than acceptable and the deviation is small. For instance,
if you come in with a non life threatening condition, you will have to wait.
That could mean waiting months for a specific surgery that you might get
instantly in the US if you had good insurance. That kinda sucks when you have
to wait and you're in pain, but is understandable unless you want to spend 50%
of GDP on health care, or prioritize people based on how much they earn.

~~~
philwelch
Historically, rich people from countries with socialized medicine would fly to
the United States for medical treatment.

We could stand to improve the quality of care for the poor in the US, but
there's lots of room to do that in the existing system. For people who have
health insurance benefits from their work, I think having a little bit more
paperwork is better than waiting for months for surgery.

~~~
purplelobster
Again, it's completely irrelevant what amazing treatment rich people get. And
please, find me any evidence that American health care is in any way better or
that anyone is flying there to get treatment. I can only find evidence of the
contrary. If I ever get seriously sick, I'll be on the first plane out of
here.

~~~
philwelch
Look, your hobbyhorse is obviously this notion that there are absolutely no
redeeming characteristics to the US health care system, so there's obviously
no point getting into a nuanced conversation with you. It's rather off topic
anyway. I regret ever thinking you were capable of a reasonable conversation.

------
bstewartny
I dont know. Its one thing when you are 65 and all your kids are grown up. Its
a whole other thing when you are 50 and have young children at home. I have a
friend with 4 young kids. He has stage 4 cancer requiring constant chemo and
pain, but he is going to fight it with everything they have in order to be
there as long as possible with his kids - and maybe beat it.

~~~
akiselev
Even that issue isn't that simple. There is no right answer to the debate
between being there as long as you can for them and not wanting to have them
experience their parents withering away and dying, entirely helpless. I have
been fortunate not to be in this position but I can't imagine the latter being
very healthy for the children. It's up to every parent and family to decide
this in their own way.

I've known two people in the medical field in this position, late stage cancer
with young children at home. Both chose to fight with drug cocktails and
experimental treatments (such as sipuleucel-T when it was in trials) but
stopped short of life debilitating treatments like chemo, although one was
lucky enough to get laser based irradiation therapy (I forgot the technical
term, but it uses an accelerator to irradiate a tumor without harming
surrounding tissue as much as chemo:
<http://www.protons.com/protons/index.page>). I never asked but I'm guessing
that they've seen all too often what the family goes through with a loved one
dying from terminal cancer and don't think it's worth the pain or suffering,
for the family or for them.

------
pan69
If, as a US citizen, you're going to have (or need) serious treatment done for
which you will have to pay a considerable amount of money it might be an
option to go overseas. I can highly recommend going to Thailand. They have
great medical centers in Bangkok with very professional and highly skilled
doctors and specialists AND you're treated like a patient who needs care.

------
rosser
This has been posted before, as indicated by ben1040's comment, but it's worth
reading again.

------
csense
The following is my point of view. I understand some people have a different
point of view, and I don't have a problem if they make it known, and their
families and health care providers respect their wishes.

But from where I sit, the dying doctors' point of view, as presented in this
article, struck me as irrational.

Axiom: Being dead is better than being alive. Under all circumstances.

I personally believe this axiom, very strongly. I'd rather spit in the eye of
death with my last breath than go quietly into the night.

It logically follows, then, that a treatment that has a 1% chance of working
is better than doing nothing, if the latter has a 0% chance of working, no
matter how extreme the treatment is.

Living longer, even in a state of constant extreme pain, is better than dying.
Well, maybe dying peacefully would be less painful for my relatives, but
again, I personally place a much higher value on my own life than my family's
feelings of sadness or whatever.

The only question which remains is the validity of the Axiom. If this world is
all there is, if when you die there isn't an afterlife or reincarnation or
whatever...then the Axiom is clearly true.

If you have strong religious belief, then perhaps your afterlife is better.
But only a _perfect_ belief that you _are_ headed to a _better_ place makes it
rational to give up. If you have a little bit of doubt -- if you're 99% sure
you're going to Heaven but 1% of you whispers that maybe there's nothing and
you'll turn into dust instead -- you still want to put off rolling that die as
long as you can. Ditto if you're 100% sure there's an afterlife and 99% sure
you've been good enough to get into Heaven, but 1% of you says that maybe Hell
is where you're headed.

If your religion forbids suicide, and there's a chance that the Judge who will
weigh your life will interpret not opting for the best available medical
treatment as equivalent to suicide, then that affects your decision too.
Although, to be fair, this cuts both ways: The suffering you cause your family
by lingering beyond your time on Earth might count against you too. Literally
"Damned if you do, damned if you don't." It's unclear enough that there should
really be a few more commandments or something, to address all the corner
cases.

~~~
btilly
My wife is a doctor. For her, seeing people die horrible deaths is not an
abstract possibility. It is something that she's seen far more of than she
wants, and is likely to see in the future again more than she wants.

Despite having no particular religious views, she would disagree with your
"axiom" in the strongest of possible terms. So would I. I am not religious,
but my preferences include not suffering horrible pain. I also am against
causing severe emotional and/or financial distress for people I care about.
Those preferences lead to there being situations where I am literally better
off dead than alive, and I have made sure that my wife is aware of what those
situations are so that she can make that decision for me if I am incapacitated
and it needs to be made.

~~~
nmcfarl
My wife is a doc as well. Her opinions and experiences map to you wife’s, mine
to yours.

This is not about life being better than death. This is about the amount of
pain and suffering you cause yourself and others while fighting off death.

------
richardlblair
I've saw this article back in 2011.

Sometime after that I had conversations with my Grandmother and Mother about
their wishes.

I now know their expectations, and they know mine. It's important to think
about death, and these situations. It's even more important to express your
feelings to those who have the power to impact how you will be treated.

~~~
fernly
This is very good, but you need more than verbal undertakings. You need paper,
in particular you need a Medical Power of Attorney, a notarized document
authorizing you to make medical decisions on behalf of your Mother and
Grandmother (and your Mother, for the Grandmother) (oh, and mutually
reciprocal ones for you and your spouse if any).

Without that paper, hospital personnel may ignore you when you say what she
wanted, in fact may feel they are legally required to ignore you.

And the paper needs to be accessible on short notice (not in a bank safety-
deposit box). It's a good idea to have a copy filed at her primary care
doctor's office.

------
patrickgzill
I don't see any statistics, just a very well-written article with some
anecdotes.

~~~
martinced
Not everything needs statistics to ring a bell.

I've seen two grandfathers of mine on which absurd medical care was given: one
was seriously ill and maintained as a living mummy for months (he did look as
bad as people who were rescued from extermination camp at the end of WWII) and
another who, while in coma, had a leg cut off although everyone knew he
wouldn't wake up. Who the heck wants to wake up with only one leg when one
know you'll die in the next few hours / days of terrible cancers that spread
throughout the whole body?

It's _precisely_ what this article is talking about because it's really what's
going on.

People dying in an environment they're not familiar with, experienced things
they never experienced during their whole life: broken ribs due to overzealous
CPR, one leg cut off, tubes everywhere.

I've had a girlfriend who was a doctor and the sheer number of crazy situation
like this she was describing were insane.

Believe me: this is very real and you probably don't want the statistics.

Because the probability that _you_ will notice, the day your day has come,
that you're missing one leg while feeling your ribs being broken is very far
from zero.

~~~
patrickgzill
No, I _DO_ in fact, want the statistics, if a writer is going to make the
claim that:

"And they don’t die like the rest of us. What’s unusual about them is not how
much treatment they get compared to most Americans, but how little."

It should be easy to prove/disprove this, as doctors get surveyed all the time
on different subjects.

------
noonespecial
It seems almost purposely designed to bankrupt you as quickly as possible so
that the agencies can start passing you around as some sort of billing token.

~~~
jonpeda
Why would agencies prefer you after bankruptcy?

~~~
lsc
you can't do it again for 7 years.

------
afterburner
"someone breaking their ribs in an attempt to resuscitate them with CPR
(that’s what happens if CPR is done right)"

Is that always necessarily true...?

~~~
elemeno
Not always, but very often.

Guidelines in the US and Europe recommend compressions which are four or five
cm deep, and that's a pretty significant percentage of the distance from your
sternum to your back. Remember of course that one of the things that your rib
cage is supposed to protect against is blows to your heart and lungs, so it
shouldn't be too much of a surprise that a procedure that is supposed to
compress your heart is also going to cause damage to your ribcage.

~~~
meaty
Yes this happened to my father. I remember the crunching sound of his ribs to
this day. This was at waterloo station in London in 1993. He just keeled over.
Fortunately for him, someone had just got stabbed 100 yards away so people
were already on hand. The paramedic didn't even blink. Everyone else shit a
brick.

He survived though and after a bypass op is fine to this day.

~~~
elemeno
It probably helped as well that St Thomas's is literally within a few hundred
yards of Waterloo Station.

The speed with which you can be in specialist care is absolutely critical when
it comes to cardiac problems - which is a large part of the reason why
survival rates are far higher in places like Central London where you've got
both fast response time for paramedics (for London as a whole, ~75% of
'immediately life-threatening' calls have a response time of under eight
minutes) and multiple world class Hospitals with specialist cardiac centres.

Even so, that's one hell of a lucky break your father had and fantastic that
he both survived and is fine still!

~~~
meaty
Very true regarding St Thomas' - that's where they took him.

Very lucky, but not for the poor guy who got stabbed. Not sure what happened
to him at the end of the day.

------
maeon3
we won't be able to repair these various cancers until we can do whole cell
emulation on the offending cell and contrast/compare it to a healthy
equivalent.

We need to understand the mechanics of cells down to the molecular level. Then
maybe we can think of a fix. At this stage in society, we know just enough
about cancers to do more harm than good in the remaining years of life for the
worst forms of cancer.

~~~
reasonattlm
There are plausible ways to fix cancer, outlined in some detail, but they are
so different from the present status quo of cancer research that the community
does not pursue them. If it doesn't look a lot like a drug, good luck in
obtaining funding for your research.

For example, WILT / OncoSENS. Which is to say turn off all mechanisms for
telomere lengthening and work around the issues that will cause by replacing
stem cell populations:

[http://www.fightaging.org/archives/2011/10/accumulating-
the-...](http://www.fightaging.org/archives/2011/10/accumulating-the-
groundwork-for-the-ultimate-cure-for-cancer.php)

<http://sens.org/research/introduction-to-sens-research/onco>

\---

Further, even a robust cure for a specific cancer based on targeted cell
killing (by surface chemistry or other markers) doesn't require a complete
understanding of the cancer cell - you just need to identify a reliable
marker, no need to understand why it's a reliable marker.

