How to Die Like a Doctor!

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Brian J. Knabe MD

By Brian J. Knabe; MD CMP© CFP®

http://www.SavantCapital.com

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http://www.CertifiedMedicalPlanner.org

If you want to fix the problem of rising costs in the U.S. healthcare system, or at least reduce the looming Medicare/Medicaid entitlement burden, there’s a surprisingly easy solution.

Washington

In Washington policy circles, it has been estimated that more than 80% of all the dollars spent on healthcare in the U.S. are incurred in the last nine days of a person’s life. Many times, the money is spent keeping a person alive in a vegetative state, prolonging an incurable illness or painful conditions where there is little to no chance of recovery. The money is not just wasted; it may actually be used to prolong suffering when recovery is not an option. It doesn’t have to be this way.

Forbes

In an ongoing blog on the Forbes website, emergency room physician and financial planner Carolyn McClanahan MD tells us that doctors are among the best at avoiding this dismal fate at the end of their lives by taking a few simple recautions.

Dying like a doctor, she says, starts with understanding that we all get sick and die. Most people know this, but don’t realize it deep down, which is why individuals who experience near-death experiences–making death a more prominent part of their awareness–often choose to live more vital and productive lives thereafter, determined to make every second count.

As McClanahan says,

“When we live with no regrets, death isn’t scary.”

Doctors also see first-hand situations in which an unconscious person goes through a battery of procedures that keeps them alive until Friday, when they otherwise would have died the previous Tuesday.

McClanahan recommends that laypersons get a closer look at the transition from life to death by volunteering at your local hospice. Finally, doctors understand the power of documentation. They make sure they have a living will that describes how they want to be treated when faced with a serious accident or illness. They’ll have an advance directive which provides written instructions regarding their medical care preferences. In an earlier blog post, McClanahan stated that it is best to focus on outcome rather than actions.

Her favorite example is the routine question: “Do you want CPR?” –which, she says, seldom works at the end of life, will crush the bones in your chest and will become just another charge on the “superbill” the hospital sends the insurance company after your death.

The Flip

If instead you turn the question around, and make it: “What type of lifestyle is acceptable to you?” –then you might answer, “As long as I can use my brain, even if I can’t move, I want to be kept going.” That means you would be okay being a quadriplegic, but don’t want to be kept alive in a persistent vegetative state. Both of these documents will be entrusted to members of the family, or placed in a safe place that is accessible to your loved ones. They’ll go alongside a medical power of attorney, which empowers a friend or relative to make financial decisions when you are unable to.

Doctors also know to designate a health care agent who understands their wishes and will act accordingly when the hospital medical team presses for permission to keep them alive when there is little chance of recovery.

McClanahan tells the story of her own father, who was diagnosed with lung cancer. The doctors recommended chemotherapy and radiation. When he decided to forego this painful treatment, the doctors were indignant, and predicted he would be dead within six months. He lived three more years, and the hospice was a blessing at the end. He was one of the few non-physician Americans who had the knowledge and the documentation to die with dignity.

Assessment

Like a doctor. 

Conclusion

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4 Responses

  1. Medicare Spent $34,529 Per Death in 2014

    Kaiser Family Foundation recently released an analysis on end-of-life Medicare spending among seniors. Here are some key findings from the report:

    • Among those who died in 2014, Medicare spending per person peaked at age 73.
    • Spending was $33,381 among 85-year-olds and $27,779 among 90-year-olds.
    • For beneficiaries who lived through the entire year, spending peaked at age 97 ($14,620).
    • 4% of people on Medicare died in 2014, accounting for 13.5% of Medicare spending.
    • Medicare spent $34,529/person on people who died in 2014 vs. $9,121 for those who lived the entire year.
    • The share of Medicare spending for people who die dropped from 18.6% in 2000 to 13.5% in 2014.

    Source: Kaiser Family Foundation, July 14, 2016

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  2. We were promised death panels

    While we may not need death panels, and we certainly don’t need care rationed by governmental bodies as the term suggests, we could certainly benefit from further discussion and consideration of what we want done to our bodies when we are facing near-certain mortality.

    As a society, we should recognize the importance of having a plan in place, and as physicians, we need to help our patients face these uncomfortable questions before the answers become necessary.

    http://www.kevinmd.com/blog/2016/07/promised-death-panels.html

    Dr. David Marcinko MBA

    Liked by 1 person

  3. When Breath Becomes Air

    #1 NEW YORK TIMES BESTSELLER • For readers of Atul Gawande, Andrew Solomon, and Anne Lamott, this inspiring, exquisitely observed memoir finds hope and beauty in the face of insurmountable odds as an idealistic young neurosurgeon attempts to answer the question What makes a life worth living?

    At the age of thirty-six, on the verge of completing a decade’s worth of training as a neurosurgeon, Paul Kalanithi was diagnosed with stage IV lung cancer. One day he was a doctor treating the dying, and the next he was a patient struggling to live. And just like that, the future he and his wife had imagined evaporated. When Breath Becomes Air chronicles Kalanithi’s transformation from a naïve medical student “possessed,” as he wrote, “by the question of what, given that all organisms die, makes a virtuous and meaningful life” into a neurosurgeon at Stanford working in the brain, the most critical place for human identity, and finally into a patient and new father confronting his own mortality.

    What makes life worth living in the face of death? What do you do when the future, no longer a ladder toward your goals in life, flattens out into a perpetual present? What does it mean to have a child, to nurture a new life as another fades away? These are some of the questions Kalanithi wrestles with in this profoundly moving, exquisitely observed memoir.

    Paul Kalanithi died in March 2015, while working on this book, yet his words live on as a guide and a gift to us all. “I began to realize that coming face to face with my own mortality, in a sense, had changed nothing and everything,” he wrote. “Seven words from Samuel Beckett began to repeat in my head: ‘I can’t go on. I’ll go on.’” When Breath Becomes Air is an unforgettable, life-affirming reflection on the challenge of facing death and on the relationship between doctor and patient, from a brilliant writer who became both.

    https://www.amazon.com/When-Breath-Becomes-Paul-Kalanithi/dp/081298840X/ref=cm_cr_arp_d_product_top?ie=UTF8

    Dr. Stanley

    Like

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