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How Doctors Die
Hugh Pickens writes "Dr. Ken Murray, a Clinical Assistant Professor of Family Medicine at USC, writes that doctors don't die like the rest of us. What's unusual about doctors is not how much treatment they get when faced with death themselves, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves because they know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. 'Almost all medical professionals have seen what we call "futile care" being performed on people,' writes Murray. 'What it buys is misery we would not inflict on a terrorist. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, "Promise me if you find me like this that you'll kill me."' Feeding into the problem are unrealistic expectations of what doctors can accomplish. Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. If a patient suffers from severe illness, old age, or a terminal disease, the odds of a good outcome from CPR are infinitesimal, while the odds of suffering are overwhelming."
OK, based on the summary I kind of agree with some of the sentiments, but then from glancing at the link, I really don't want to read the bitter, angry thoughts of Ken Murray and hear about how little he thinks of the medical profession and how futile he thinks life is. Ken, buddy, have a nice cup of coffee, treat yourself to a scone, and let the rest of us continue to muddle through the way we always have.
Breakfast served all day!
It's traditional to see life as a sacred thing that must be preserved at all costs--to a point. There was a balance. This has been true throughout human history, with the exception that in the past couple hundred years we seem to have collectively forgotten that in order for life to go on something else has to precede it in death. In an era of ever-increasing lifespans, global populations and expectations of one's quality of life, we are engaged in a losing game against the power of exponential arithmetic.
When it's time to go, it's time to go.
and not screaming in terror like the passengers in his car.
But all kidding aside, I agree that the so called "futile care" exists for the patients loved ones and not the patient themselves.
"Have you ever thought about just turning off the TV, sitting down with your kids, and hitting them?"
In the US, healthcare isn't about getting people better, it's about maximising profits. So, on that basis, it's perfectly okay to keep people alive and suffering terribly as long as there's still a few dollars to be squeezed out of them. Patient dignity and welfare doesn't come into it - the hospital administrator needs a new Jaguar!
It's also a shame that "futile care" is what so many expect in near-end-of-life treatment. These costs can add up to significantly more than all the health care costs up to that point. So our insurance costs are loaded with the costs of futile care.
To put the IT spin on this... it somehow reminds me of when people show up with the 10 year old computer and want to see if it can be upgraded to last a bit longer. The IT professional will be fast to tell them to just bite the bullet and get a new computer already! They know when it is time to give up.
"Never give up, for that is just the time and place when the tide will change." -Harriet Beecher Stowe ^_^
Of course physicians can make better informed decisions, they are pragmatic and know the results and outcome of disease
But what about when their child gets sick? Do they make the same decisions then? It is one thing to make those decisions on your own, but what happens when it is applied to someone else you care for?
I assume the results are different.
People often view warriors as noble respectable people for how they choose to die , on the battlefield rather than like a coward in their living room.
How is it that the same people then turn around and ask for the machine holding their loved ones alive to be unplugged to end the suffering ?
I would by far prefer to suffer excruciating pain as I inevitability die rather than have my family or friends unplug me to ease the transition. Let me make the decision on when I want to die. If I have to suffer through pain and agony as I die so be it , but don't tell me you're doing me a favour by letting me die.
I thought Doctors didn't die, they just regenerated? Unless of course they were killed while regenerating.
It's better to burn out than to fade away
...almost completely. There is a point, and we can certainly debate just where that point is, beyond which we are no longer "healing" and are merely prolonging the suffering of our patients. The common layman's expectation is that anything that could be done, should be done, regardless of the likely outcome. Pointing out that Grandma's time has come, so to speak, and that the "right" thing to do is to make her passing as comfortable as possible, is something that western medicine does not do, generally. That needs to change.
a patient suffers from severe illness, old age, or a terminal disease
Had one branch of the family that was real religious. Didn't believe in anything even *resembling* euthanasia. Insisted on keeping my aunt alive, no matter what. It was an ugly, sad end. Bad stuff.
Had another branch that had a much better attitude, IMHO. Had hospice care that was not afraid to push the painkillers well into the dangerous zone, a "do not resuscitate" understanding with the hospital, etc. My cousin's mother died a *much* more noble death.
Can't stop death from coming. And there is a time to fight for life, but also a time to recognize when the fight is over.
SJW: Someone who has run out of real oppression, and has to fake it.
I work in a hospital (nurse) and the sentiment from all the staff is identical to the article.
It seems we have so far done a great job of extending the old-age and dying years of life.
Isn't it more likely they are trying to get rid of there own empathy for how others feel. They see families worried and scared and so on when loved ones are hurt, sick and dieing that they want to be selfish in the regards of not having that happen to their family when they are in the same position?
Never subscribed to the whole "if I'm that bad, pull the plug" stuff.
Maybe I'd feel differently if I'm ever actually in that situation.. but my gut reaction has always been as George Carlin would put it "screw that, save my ass!".
>For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves because they know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want.
Many people are absurdly clinging to their lives spending too much money on doctors in the dusk of the lives. I am reserved right now not spend more than 10K for my health. Forget about heart surgery etc. If my deductible (or whatever the part I am paying after insurance payment) is more than that, I'd rather die and leave this money to my dependents.
I do not believe in karma. "Funny"=-6. Do good and forbid evil. Yours, Oft-Offtopic Flamebaiting Troll.
Unless the doctor officiously attempts to prolong life, no matter how painful or futile that prolongation is for the patient, the patients relatives are going to sue that doctor to the hilt for not doing their utmost for the patient. Ease the patient out and its a murder rap. "Ars Longa Vita brevis", but not if you're talking to a litigeous lawyer!
Which is why my wife and I worked this out LONG ago:
Pull the damn plug.
Don't tell me to get a life. I'm a gamer; I have LOTS of lives!
Why is "letting go" always the compassionate, noble, or dignified choice? Everyone has his own preferences and I won't begrudge anybody theirs. But death is death. What I know for certain is that I do not welcome it. When I'm given the option of a prolonged five months of agony leading to the inevitable end or a quick relatively painless couple of weeks, I know for a certainty that I'm taking the pain and the time. Hey, if you or anyone else makes the opposite decision, that's your thing. But let's not pretend there's something more dignified about being accepting vs struggling to the end. They're preferences not absolutes. As for compassion, well, what's compassionate for a person is up to him to decide.
So Anonymous was right? I should just kill my self now? Everyone told me it was trolling? I feel so empty inside, how could they lie like that. I don't think I'll even go to the rest of my marketing meetings today.
and not screaming in terror like the passengers in his car.
But all kidding aside, I agree that the so called "futile care" exists for the patients loved ones and not the patient themselves.
Ugh. I LOLed (unfortunately). Well done.
Over 50% of health care spending goes to pay for the last two weeks of life.
"To those who are overly cautious, everything is impossible. "
Of a neurologist who had a stroke, and wrote an article about it later. It was really amusing how she wrote about it. She knew what was going on, she knew the signs, hell, she was an expert. She called for help of course, but, she talked about how during it, she was having a rich internal dialog about the process... thinking of what functions were broken, how it was manifesting and how she experienced it....
I think that is a lot of it. Other studies have found that the groups who spend the most on healthcare at the end, and spend the most time in hospital beds prolonging life are... the religious people. Atheists are much more in line with doctors. Why?
My own hypothesis, which fits my own experiences to is... that belief in an afterlife, in the absence of other experiences (like working in healthcare and seeing people die all the time), lets people ignore death. It happens later, there is life afterwards, everlasting life.
Atheists and people who deal with death on a regular basis have no such excuse. As an atheist, I came to terms with the lack of an afterlife early. I remember being maybe 14 years old when I realized that I was going to die, that was going to be it....and even that.... I didn't want to spend my time in a hospital bed. I knew...then...at 14, that when the time came, I would want to just die, even if it meant taking my own life. Not a desire to kill myself now or anything depressing like that, but an affirmation that life will someday not be fine, and never be fine again, and that when that happens, I know I can check out.
I have talked with some people who struggled with suicidal thoughts, serious ones, not attention whores. A few said that when they decided how they wanted to die, and put together a cyanide pill or some such.... just knowing it was there was enough. Knowing that they could end it provided a sort of final resolution, a comfort that allowed them to move past it and stop thinking about it.
On the other hand, I feel bad for the very religious. Doubt is common, almost inevitable. How can you not be on your death bed and wondering if those stories were true? For a religious person to be wrong, could mean so many things, hell, a different religions hell.... what if you chose the wrong god? For me as an atheist, whats to doubt? If there is an afterlife, great....but a heaven one seems just as unlikely as a hell. We literally have nothing to worry about.
"I opened my eyes, and everything went dark again"
They won't have sentiment or 'feelings'. They'll fight to save our lives and won't be burdened with any negatives, such as ethics or morals ... as long as our credit is good.
'What it buys is misery we would not inflict on a terrorist." Not only is he not American, but he clearly has never met one, either. Strange how he works in Southern California....
IT has something similar. Everyone of us has experienced it.
Poor bastard brings in a laptop with that forlorn look on their faces. "Dude... save my porn". You boot up and the drive is not recognized. Take it out, hook it up it for diagnostics and it is dead. No S.M.A.R.T status, nothing. You gently touch the drive and there are no RPMs .
You sit him down, and explain carefully, that the drive is dead. It could have been overheating from leaving the laptop on the bed while going to town with that whole bottle of hand lotion.
There is an outside chance, experimental even, that you could open the drive and transplant it into a working one. The transplant waiting list is not just long, but extremely expensive and not guaranteed. (I had one guy explain to me that the platters looked like an airplane came in for a hard landing and scratched the whole surface deeply).
He leaves laptop in hand, tears freely flowing, and you look to your buddy and tell him, "Dude if I ever lose my porn like that just kill me". Then you remember that you have knowledge and it is protected with ZFS and scrubbing. Thank God.
Some years ago when my grandmother entered the final stages of her illness--and her life--her longtime physician issued a "Do Not Resuscitate" order. He informed us one afternoon that her end could come at any time. Because she was a religious person, we ensured that she received the appropriate religious rites. Then we settled down, quietly, to watch and wait with her. It was somewhat inspirational and comforting, as she began to "see" friends and family who were long gone and to speak with whoever she was visualizing. She drifted in and out of consciousness. Late in the evening she appeared to fall asleep, we left to get some dinner, and that's when the whole thing went out the window. Her heart stopped, and instead of just letting her go, the DNR order was disregarded, the resuscitation equipment was brought in, and the hospital staff set to "work" on her. It's brutal. It can be like beating up on someone. Fragile old ribs can be broken, the body is bruised, and there is a great deal of noise and pain.
They succeeded in restoring her heartbeat, and she lingered for another two days in pretty severe discomfort. The doctor was livid and handed out appropriate reprimands, but by then it was too late for my grandmother. She was robbed of what had been a peaceful end-of-life interval, and we were left with a boatload of guilt for taking a break and leaving her unguarded from the people who were supposed to be following her doctor's instructions and taking care of her.
Do what you can to safeguard your elderly relatives from this. It's brutal, violent, pointless, and turns a quiet death into a three-ring circus of pain for the victim.
"Here's what's happening. You're starting to drive like your Dad..." - Red Green
Cut into your body, remove things you don't need, without killing you.
Sew you back up.
Set bones - with or without surgery
Kill infections
Figure out what is killing you
Cut into your body and move things around (i.e. plastic surgery,
Tell you which activities/things are bad for you - particularly if they first diagnosed you with a specific issue.
If you ask them to do much more than that, you get temporary fixes. Kidney transplants, pacemakers, etc. all have a relatively short life expectancy.
excitingthingstodo.blogspot.com
Well, I'm not entirely sure on that one. First, there are disputes over how to even perform CPR for maximum effectiveness, with some saying that chest compression alone produces better outcomes than a mix of chest and breathing. If the doctors aren't in agreement over what CPR should be done, and different methods are being rolled into a single line item, then the statistics for the outcome really don't mean anything useful. It tells you that *something* is ineffective, but it cannot tell you what that something is.
Second, all doctors either swear to the Hippocratic Oath or implicitly sign up to it by becoming doctors. Since the Oath is witnessed by an independent third party, it is arguably a legally-binding common law "gentleman's agreement"/"verbal contract". Technically, the Oath states that doctors should do no harm and minimizing suffering is technically doing just that. However, very few Western nations interpret things that way. If they did, assisted suicide under well-defined conditions* would be legal. It isn't because they don't. As such, doctors end up in a double bind. Do they do the clinical least harm or the legal least harm? Whichever one they do, they violate the other.
*I am not a fan of assisted suicide, but the only way to bring the ethics and law together is to have some cases where it is legal. IMHO, the Oath should move from common law to contract law and be the defining standard. It's a "floating" standard, since different levels of technology and understanding will alter what least harm is actually achievable, and it is a far more credible benchmark than the religious and political whims of the day.
It's a small world and it smells funny; I'd buy another if it wasn't for the money; Take back what I paid (SoM)
I will join the army at age 80 and the enemy can cut me down in a hail of gunfire.
We won't be able to have a reasoned discussion about End Of Life issues in this country for another generation, at the soonest. The well was poisoned by the Republicans. Fuck You Very Much, Assholes!
I have been told by doctor friends that it is common practice to slowly increase the morphine drip on patients with end-stage illnesses to provide additional "comfort". The doctors understand that the patient's body will likely succumb to the affects of the drug and "slip off".
Of course, one of the doctors telling me this winked and said "I'VE never done it, mind you."
Really it's a convoluted mix of several things that account to a poor death experience in the States. Doctors are under orders to do everything they can and money is not a consideration. Insurance companies don't want hindsight 20/20 lawsuits alleging that more could have been done. There is a general "religious-y" feeling that people die when "their time has come". And the families almost never want to "let someone go".
In the end many people either suffer weeks of painful life-prolonging treatments or spend the last days in a drug-induced coma. I would guess that many west European doctors would be amazed, medically impressed, but ultimately dismayed at the lengths we go to keep 90 year old patients alive.
Of course physicians can make better informed decisions, they are pragmatic and know the results and outcome of disease
But what about when their child gets sick? Do they make the same decisions then? It is one thing to make those decisions on your own, but what happens when it is applied to someone else you care for?
I assume the results are different.
Your point would be better served by considering what a doctor would suggest for a spouse, or parent.
With a minor, there is the issue of consent. An adult has ultimate control over their own treatment; with a child, the parents have the ultimate say in most cases.
Moreover, depending on the situation, a child may have the potential to live an entire lifetime if treatment succeeds, whereas an elderly patient may only live another few years.
I'm dismayed by the same poeple who buy the latest gadgets to "keep up" but at the same time have a Middle Age attitude about medicine and life span.
My mother died last month. She was a physician who worked primarily with elderly patients in nursing homes so for her losing a patient was a regular occurrence. She had a bad bout of pneumonia and her lungs were not recovering, so I had to make the hard choice whether or not to put her on a ventilator in order to keep her alive. My justification was that the respirator would only be used for a short time in order to give her lungs a chance to heal and recover. When it became apparent that she was not recovering, I had to make the decision to remove it and allow her to die naturally (it took less than an hour).
My mom did not have an advanced directive specifying what kind of care she wished to receive if she were unable to choose for herself. This made my decisions very painful and difficult. I remembered the conversations I had with her about her caring for her own patients and how sometimes the families of her patients would request extreme measures at the end of life, and how this would contrast with borderline neglect during the patient's life.
My mom also was opposed to assisted suicide. That much I knew. She felt life was a gift that shouldn't be wasted or rejected.
In my mother's case, it was clear that if she were to survive she would need to be on the ventilator for an extended period of time, and enough time would pass that she would deteriorate physically due to being immobile in a hospital bed. Also, she was in the early stages of Parkinson's and it was almost a given that this violent shock to her system would result in an acceleration of its effects.
Knowing that if she did recover her quality of life would be greatly reduced, I made the tough choice to let her go. One advantage of this was that I was able to hold hand, stroke her hair, and sing to her as she died surrounded by family. She was 73. I encourage everyone regardless of age to set up an advance directive determining the level of care they wish to have. It wouldn't have prevented my situation, but it would have made it easier if I knew ahead of time what mom wanted.
It's not only a problem of unrealistic expectations by patients.
There is also a conflict of interest between the doctor's duty in the best interests of his patients and in the best interests of the medical practice that employs him. A principled doctor can stay on the honest side to a large extent, but take transparent honesty too far and your career prospects are threatened.
It's not really all that different to how it is in other professions. However, other professions don't have the same direct effect on human life and suffering, so the problem stands out a bit more in this discipline.
It's especially bad in a country in which the medical industry is extremely lucrative which has the inevitable consequence that medical insurance is astronomically priced. That turns everything into a money game, and the result HAS to be bad medical practice: after all, a doctor cannot offer the same level of service to a person without money as to one who is rolling in it, because if he did, what would the rich person be paying for?
Money distorts everything, but the effect is particularly harmful in the health profession.
"The question of whether machines can think is no more interesting than [] whether submarines can swim" - Dijkstra
She is amazed how many people are "full code" (meaning the staff must do anything to save them), even when they are very old and frail. It is usually the family that wants this. They don't realize what this will mean in reality. It means that if their heart stops they must do chest compressions which will probably break the persons ribs when they are old and fragile.
It depends. If you're trying to compile multiple projects simultaneously in Xcode then, yeah, get the new machine. If they're just running Word, IE, etc, that 10 year old machine can still do the job. And why not use an otherwise perfectly serviceable machine? One of my cars - Toyota Rav 4 - is going on 10 years. I have no intentions of replacing it just because it's 10 years old.
1) Not all doctors take the Hippocratic oath. I am a doctor, and while I appreciate the sentiment behind the oath, I did not swear it myself.
2) There a many different forms of the "oath". Nobody today takes the oldest know form, which of course is likely not the "original" (it is unknown if Hippocrates actually was involved in the original oath anyway). Did you know that the original oath prevents a physician from performing urological sugery, abortions, or assisted suicides? And did you know the original oath required the oath-takers to give free medical care and support to their teachers for life?
3) Medical ethics has moved way, way beyond this simplistic and confusing Oath as the end-all-be-all. Re-adopting it would be like swapping out the laws of England with sharia law, or even the ten commandments.
Bringing up "the oath" is entirely irrelevant to the discussion and is a red herring. It would also be a big step backwards to include it in physician training in the future, except as a historical curiosity.
"First, there are disputes over how to even perform CPR for maximum effectiveness, with some saying that chest compression alone produces better outcomes than a mix of chest and breathing."
There is pretty close to ZERO dispute over how to perform CPR. Compression-only CPR is intended for untrained individuals who may be under stress; it's easier to just simply keep pumping than to keep track of "how many compressions have been done, oh, now it's time to take a breathe". The average person may be more reluctant to put their lips on a complete stranger; it's also more difficult to alternate between breathing and compressions if there's just one person available. Paramedics, EMTs, etc do both compressions and ventilation.
http://humour.200ok.com.au/image_nicebigcup.html
bjd
My mother had a stroke this fall, and passed away as a result. She had an advanced directive in place, and my brother and I had medical power of attorney. Fortunately he and I agreed on what steps should be taken, etc.
The medical people we dealt with were absolutely wonderful. I live 600+ miles away, and prior to leaving I managed things over the phone. They took the time to explain to me exactly what was happening, what the prognosis was, etc. Nor was this an open-and-shut case at the start, but as things developed further it became apparent what the end would be. They always informed me, answered my questions, and respected my opinions.
By the time I got there, she was in the palliative care unit and they were keeping her out of pain, though by that time consciousness was long gone. They treated us well and were always concerned about how we were managing.
Four years ago she had a fall, hip replacement, and a tough time coming out of the anesthesia. The medical people were helpful and informative back then. She recovered, though went into assisted living instead of to her own home for her last years.
There are good medical professionals out there, and they're not all money-traps. There are also families out there who are not in the, "Do everything you can to keep Mommy alive!" mold. I have nothing but good to say about the terminal care she and we received at the hospital. Just before Christmas we received a few additional mailings about their grief counseling services, recognizing that things like this tend to hit hard in the holidays, especially the first after a loss.
Been there, done that.
The living have better things to do than to continue hating the dead.
Just do it like they do on the Discovery Channel. They die. The living huddle around for the minute and then leave the dead on the side of the road. The world is over populated, you're a burden on society and you're only going to suffer anyways. Stop being a pussy, face up to the inevitable and let those wearing their hearts on their sleeves and singing their bleeding heart sonatas go f*ck themselves.
This is the exact reason I carry a DDNR and a Med Alert style bracelet stating that.
If I'm to that point, most likely I'd do little more than put my family through hell during rehabilitation, both emotionally and financially for a possible good outcome.
My wife has a friend whose husband was injured in an accident prior to Thanksgiving, he is still in the hospital and is still in CCU, with little to changes for the better. A DDNR would have saved his wife the roller coaster of the dr's saying he is improving only to have him lapse into a worse state. Had he carried a DDNR she would be mourning his passing, but would also have the peace of mind of knowing the final outcome instead of 3 months of hell only to find he won't make it.
I am Bennett Haselton! I am Bennett Haselton!
I was told that applying oxygen along with chest compressions is better than compressions alone.
However...and this is important...911 operators who are trying to coax someone into giving CPR can usually get them to do the chest compressions, but all too often when the operator tells someone to breath into the dying person's mouth, the line goes dead, as does the person. When the EMTs arrive the person who was giving CPR will have faded back into the crowd. This was from an Austin EMT instructor.
Also, a nonskilled person might take too long switching from compressions to breaths and back, during which time overall blood pressure drops. It takes a while for pumping to boost blood pressure sufficiently to move it around to the brain, so the pauses to put more air in the blood can be worse than just moving around what little air is already there.
In other words, the science is pretty clear: oxygen with compressions is better than compressions alone. However, the sociology is in debate as to whether or not bystanders can be made to do things the better way, or if the less-good-but-better-than-nothing way is more likely to be implemented.
It doesn't hurt to be nice.
Most people with a degenerative disease really have multiple nutritional deficiencies. Illness get compounded when doctors, instead of testing for nutritional problems prescribe powerful drugs which cause more illness. Sad really.
I wonder if the manufacturers of drugs that help delay/prohibit nutritional testing aren't really insane. Really. The definition of insanity that your local coroner uses is: "Is a person an immediate danger to themselves or others?" One could argue that officers of major drug corporations are "insane" because they harm themselves and others by lying about the importance of nutritional testing to prevent degenerative disease and offer their product as the only "cure".
Drug companies have been claiming to work on cures for degenerative disease, lets be generous, in earnest after WW II. Which diseases have been cured? Our government has given billions of dollars for nothing. Zero. Nada. Niente. No cures. Pitiful.
And to those misguided souls that are under the misapprehension that their particular favorite drug can extend and increase their quality of life I just hate to be the one to rain on your Polyanna parade. Not gonna happen. Before you even reply to this post to crush me with your fiery flawlessly logical and all knowing rhetoric just read the label on your drug to see how dangerous it really is to use it.
Vitamin D3, cholcalciferol, an essential nutrient decreases in the human body as it ages. So supplement with 4,000 iu a day for 6 months. It won't make you blind, destroy your liver or use up all your magnesium and give you a heart attack. It will just contribute to your well being and high quality of life.
Do you need supplemental D3? How about vanadium or chromium? I don't know if you do or not. You should make your doctor order the proper test from a certified lab to find out.
You do what you want to do. I'll bask in the natural high of proper nutrition.
about how useless competition is in health care because you need too much specialized knowledge to make informed decisions, are too distraught to do so and don't use the service enough. This is interesting since it looks at it from the other end, e.g. someone with the knowledge to weigh their options for real.
Hi! I make Firefox Plug-ins. Check 'em out @ https://addons.mozilla.org/en-US/firefox/addon/youtube-mp3-podcaster/
Cut into your body, remove things you don't need, without killing you.
That depends on what they need to remove - not all tumors have well defined boundaries and they often have to followup with chemo or radiation therapy to make sure they got it all.
Figure out what is killing you
As long as you have a well recognized disease. My sister spent a year of unnecessary and ineffective treatment for a relatively rare condition that was much better controlled once she was on the right meds.
If you ask them to do much more than that, you get temporary fixes. Kidney transplants, pacemakers, etc. all have a relatively short life expectancy.
A kidney transplant lasts around 10 - 12 years on average. Even if it's not a permanent fix, it sure beats spending 4 hours on a dialysis machine 3 days a week. Over the lifetime of the transplant, it will have saved 6200 hours (260 24 hour days) of sitting on a dialysis machine.
A pacemaker lasts 7 years on average, and the original placement is a relatively minor surgery done under local anesthetic - a replacement is even easier since typically the leads don't need to be reimplanted. My father is on year 14 with a pacemaker, and has had one replacement. He is very happy with the performance of the unit and is thankful to have it.
I'd say that pacemakers are something that doctors do exceptionally well - it's a relatively low-risk surgery that is nearly routine in nature and gives an excellent prognosis. Don't confuse the life expectancy of the treatment with the life expectancy of the patient. A painkiller may last only hours, but when I have a headache, I still take an aspirin.
Not really. I know at least one person that's been on dialysis for most of his life.. and pacemakers are a decently working thing too.
In the end every fix we know is temporary - like that Onion article said, the death rate is still 100%
I must assume that you refer to the "Modern Oath", because the original Hippocratic Oath is very clear:
"I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan"
I'd have to say that the many variants on heart surgery are pretty major exceptions to that. From bypass to valve replacement to a full artificial heart. They are all pretty reliable and can add many years of very productive life and for the most part a "full recovery". Artificial joints are pretty great and quite reliable as well. Hearts and joints both perform simple mechanical functions that we can emulate pretty well. Other organs are much more difficult.
The main thing is to try to have a level-headed talk with your doctor and ask what the prospects are.
But 10-12 years for a kidney? Tell that to a kid with kidney problems. Cripes, tell it to a 40 year old man.
Pacemakers is a better surgery, but still - 7 years is not enough. Short term fixes.
excitingthingstodo.blogspot.com
I know that you're obviously a troll or just so brain-washed that you believe this kind of crap, but....I'm going to make a case for it. While watching my mother die the slowest, most painful death around (Alzheimer's) my sister and I prayed over and over for even the option to end her suffering. Not an option in America. At the same time, I couldn't help but notice others in the nursing home - worse off - but whose families insisted on prolonging things for what I consider to be their own selfish motivations. Yes, I said selfish. While focused on trying to avoid their own impending loss of a loved one, they never took any consideration for the ongoing medical torture being perpetrated on the patient. Every time blood pressure spikes - Bam! A trip to the ER with all of the attendant poking, prodding, jabbing, muscling their bodies around.....Fucking medieval.
In terminal diseases (end stage cancer etc..) CPR never works and if for what ever miracle it did work, you're not back to square one, you're back to the end stage disease that brought you there. So...if I'm there, let me go.
Disclaimer: I'm a palliative doc.
Certain cases of cancer, like pancreatic, unless found out very early, are rather pointless to treat.
However, what worries me is, wouldn't adhering to his model deprive medicine of data and subjects needed to improve present cures and develop new methods?
I mean... the operation the article mentions has a success rate 15% - triple compared to old type. Suppose that with enough time, someone manages to triple the success rate again, to 45% - by then it's looking reasonable as a method. But if experiments can't be done , we aren't really going to solve anything.
Perhaps the solution would be pruning the uneffective methods, and paying patients who decide to undergo experimental treatment - truly experimental i mean, not just repeating things that usually don't work well.
I finally get to join the club! The elite and ever whiny "I read this on an obscure technology/politics blog two months ago and slashdot is just posting it now?" club.
But seriously, this made serious rounds pretty quickly in medical and sociological circles, and even I read it more than a month ago. I'm actually astonished such an active submitter as Pickens didn't get it through till now. It's pretty much talked to death everywhere else (pardon the unintentional pun), and it's not exactly an old conversation to begin with. Most doctors feel pretty similarly to Dr. Murray; they've been saying these things to each other for years as far as I know. They're not all brave enough to respect a patient's verbal requests over family and staff objections (although even here Murray says he had copious, accurate notes of his correspondence with the patient), but Murray's blog hardly describes anything new or emergent.
"What it buys is misery we would not inflict on a terrorist." No, I would inflict a lot more.
Conservative, mod down for violating
Few doctors in Sweden swear the Hypocrite oath(the original, strict Hippocratic oath forbids the doctor from engaging in surgery for example), and those who do swear an altered version(that allows for surgery, and also shutting down life support apparatus when it's clear that it will just prolong pain with 0 quality of life).
As a swedish paramedic, I have sworn no such oath, nor would I ever do it.
Also, as a trained paramedic, we always do compressions+breathing, the compressions-only thing is a quick mnemonic taught to people who aren't trained, but they can perhaps manage to save someone.
Utterly tasteless. Perhaps the parent has never had to deal with the death of another human being.
Well, I'm not entirely sure on that one. First, there are disputes over how to even perform CPR for maximum effectiveness, with some saying that chest compression alone produces better outcomes than a mix of chest and breathing. If the doctors aren't in agreement over what CPR should be done, and different methods are being rolled into a single line item, then the statistics for the outcome really don't mean anything useful. It tells you that *something* is ineffective, but it cannot tell you what that something is.
That's not actually quite correct. The current debate isn't about whether hands-only CPR is more effective than full CPR (It's not), the question is whether hands-only is more easily performed correctly than compressions/vents, and is, on average, going to be more effective as it gets performed in the field, add into that the fact that hands-only is easier and faster to teach, and maybe we'll have more of the population able to perform CPR, which means a decrease in time from arrest to start of CPR, which will always improve outcomes.
Second, all doctors either swear to the Hippocratic Oath or implicitly sign up to it by becoming doctors. Since the Oath is witnessed by an independent third party, it is arguably a legally-binding common law "gentleman's agreement"/"verbal contract". Technically, the Oath states that doctors should do no harm and minimizing suffering is technically doing just that. However, very few Western nations interpret things that way. If they did, assisted suicide under well-defined conditions* would be legal. It isn't because they don't. As such, doctors end up in a double bind. Do they do the clinical least harm or the legal least harm? Whichever one they do, they violate the other.
Well, here we get into bioethics, which is a tremendously involved field, but I'll just give the nickle tour of the applicable issue.
The big one is the notion of patient autonomy. The patient (or their appointed medical decision maker) gets to choose what happens, provided they are competent to do so. As a medical professional, it is my job to determine what course is most appropriate, explain it to the patient, and once they understand what's going on, what the pros, cons and risks of the treatment are, they give me consent and I do it, if they refuse consent, I find the next most appropriate thing...rinse and repeat. In cases where there are multiple courses which balance the pros/cons/risks, I present them all, and let the patient choose.
A couple of quick sidelines we need to explore here, in order to have a decent understanding of the beast.
First is consent, and the second is competency, and the two are very closely linked, so we're going to do them as one.
There are two forms of consent, implied and expressed, expressed is relatively easy, the patient says "Yes do that" or "No go away.", alternatively, actions can be interpreted as expressed consent, if I need to take someone's blood pressure, and when they see the cuff in my hand, they roll up their sleeve, that's expressed consent...this can, of course get a little murky, and is part of why I have to carry malpractice insurance, since if I do something a competent patient didn't want, even with the best of intentions and in the full faith that I had been given consent, technically, I've just committed battery.
Implied consent isn't nearly as clear cut as that. Implied consent is used when a patient for one reason or another is not capable of giving consent, it could be because they're unconcious (obviously not going to be telling me to go ahead), they're a child (You're not legally competent until you're 18, or a variety of rare loopholes), they're confused and disorientated (If you don't know where you are, you surely can't understand medical procedures) or they're in the midst of a psychiatric emergency (If you think I'm a giant talking turtle, you're not going to understand medical procedures.). In the care of implied c
I needed a sig so people would know who I am, but I was too drunk to make something witty, so you get this instead.
I drink about 4-8 cups a day of the black gold. Of course, I'm aware of my addiction. I keep the coffee black so as not to add unwanted calories with sugar or milk. About every two months I do a detox and quite cold turkey, the migraines are a killer. Then I switch to tea for a while. Inevitably I go back to coffee though, once detoxed, the attainable caffeine buzz is better than ever. Besides, I hear coffee prevents cancer, so its a double win.
Agreed. Especially that dialysis is under-administered, because fucked up insurers simply won't cover more of it. People on dialysis feel sick most of the time. There was a study where they dialyzed the "heck" out of people, just to see if it'd help. And of course it did help, but IIRC the patients needed dialysis for 8 hours every day, and they felt just as good as any person with full kidney function. So dialysis is something I don't wish on anyone as a "permanent" solution. It should be a life-preserving stand-in before a transplant. I'd much rather take risks of a transplant than suffering on dialysis. Recall how you feel when you'd describe yourself "under the weather". Now imagine feeling that way every day of your life while on dialysis. That's how insufficient dialysis makes you feel: it keeps you alive, but the quality of life is quite poor.
A successful API design takes a mixture of software design and pedagogy.
What you said used to be true.
There is new information, there was even a slashdot story.
Exactly, that is what the new information is; that what you describe is in fact the old belief, and that applying actual oxygen is useful, but blowing into the lungs isn't. And they were measuring skilled people, not unskilled. That's the new way; just focus on your compressions, regardless of how good you are.
As managed care gets more and more expensive, expect to see more and more articles like this, convincing people not to bother with wellness treatments and just die. It saves money. Soon we'll be back to the life expectancy of a Third-World country, in the lower 60's.
In almost ALL cases CPR is useless. TV shows make it seem like it is some kind of death reversal. Unless you have EMTs arrive quickly CPR is almost pointless.
I know it's a difficult subject that many people are uncomfortable discussing, but please talk to your loved ones about their wishes regarding end of life care.
I recently lost my father. He was never one to discuss his feelings, but that wasn't much of a problem in life. I would have less terrible time if I understood his wishes clearly when it was time to decide to take him off life support.
I think you mean for nearly-dead patients.
I know a few people who have had pacemakers for many, many, years, and one forty-something fellow who had a heart transplant over 20 years ago and is alive and well. They were all people who would have died at a young age otherwise.
The urge to keep someone alive is also heavily weighted for age. Responders will do everything reasonable to keep someone under 50 alive, someone over 80, not so much. The circumstances are highly subject to case by case judgment, which is usually correct.
Give a man a fish and you have fed him for today. Teach a man to fish, and he'll say "WHERE'S MY FISH, YOU IDIOT?"
And had friends die of cancer. I've had cancer for that matter. Believe me, you're doing nobody any favors by putting off the inevitable. In a sane world, you'd have access to all the hallucinogenics and morphine you wanted from the moment you were diagnosed as terminal. Unfortunately, crazies drive AND vote so we're forced into these excruciating situations in the name of "valuing human life" (or whatever the conservative politicians are pushing these days).
Please do not read this sig. Thank you.
You mean this one:
Taken absolutely literally, it only forbids one kind of abortion. I would interpret this, in light of "I will follow that system of regimen which, according to my ability and judgement, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous" to mean avoiding any kind of abortion that is likely to be destructive to the patient, but that any kind that is likely to be helpful to be entirely legitimate. The requirement of being for the benefit of the patient is, IMHO, the ruling clause and all others are contextual interpretations of it.
Urological surgery, the Oath states, should be performed by a specialist. I don't see any technical problems with this -- I wouldn't want a GP to be performing it either. Surgery is best left to surgeons, as the Oath says. ("will leave this to be done by men who are practitioners of this work"). General Practitioners are not brain surgeons, heart surgeons, urologists, etc, and should indeed refer the patient to a specialist. (I don't consider surgeons to be doctors in the sense meant by the Oath. The Oath seems to make it clear that it is intended for village doctors making house-calls, or GPs in local practice, with similar but suitably-adjusted Oaths being required of those trained in highly specialized areas of medicine.)
Frankly, the Laws of England would be better served if attempts to revise or delete elements of Common Law were examined in light of the original intents of such law, and if both the Houses of Parliament and the practicing lawyers were familiar with the purpose of Alfred's Book of Dooms, the elimination of Sovereign Immunity in the Great Charter, and the reasoning behind the English Bill of Rights. Sure, nobody would want to revert to Saxon law, but the reasons for why it was what it was have changed surprisingly little. It was a careful balance of revenge, punishment and mercy, a balance a lot of modern laws don't have. We've progressed a lot in theory and can strike a much wiser balance today, but unless you start from the
It's a small world and it smells funny; I'd buy another if it wasn't for the money; Take back what I paid (SoM)
Oh, and free education (as per Christ's Hospital in the UK, and universities prior to the abolition of the grant system) produced superior numbers of graduates with superior skills to the education produced by the "free" market of loans and deprivation. At this point in time, with the skills demanded by modern trades, there should be no such thing as paid tuition up to BSc level in most fields and MSc/MPhil in the medicines. 100% of students should be in school to 18 and 80%+ should remain in schooling until they complete either a university, technical college or trade school course of a "higher education" standard. What they learn would depend obviously on what they need, but you need to know more today, not less. There will always be a pyramid of employees, with people at the bottom working the hardest for the least rewards, and nothing can change that. Mechanization and technological improvements should raise that pyramid, though, not trim it. A greater population needs a greater range of opportunities and a greater set of skills to make use of them. Less is never more.
It's a small world and it smells funny; I'd buy another if it wasn't for the money; Take back what I paid (SoM)
http://www.webmd.com/heart-disease/news/20101005/chest-compression-only-cpr-saves-more-lives
It's a small world and it smells funny; I'd buy another if it wasn't for the money; Take back what I paid (SoM)
I saw a couple of friends go through chemo for lung cancer in the 90's. One of them died of the treatment. Lungs filled up with fluid or something the first time he went in. The other one died a year or so after being diagnosed. Neither looked like a particularly enjoyable close to otherwise great lives. Personally I'd rather check out on my own terms when I've run this husk into the ground. I'm sure I can find a suitable method when the time comes.
I'm trying to teach myself to set people on fire with my mind... Is it hot in here?
Actually this is not right at all. Compression-only CPR has been proven as equally as effective if not more in out-of-hospital settings as perfusing the blood (and the small air exchange that happens with compressions) was found to be more effective in positive outcomes than breath'ed CPR. It also adds the general benefit of not having the possiblity of that person puking in your mouth (potentially disease-causing) or catching something from the person (say said person had poor dentition and their gums were bleeding/they had hepatitis b/c or hiv)
This is a crosspost from META, even the same summary/leadin paragraph is the same!
http://www.webmd.com/heart-disease/news/20101005/chest-compression-only-cpr-saves-more-lives
"There may be additional benefits to this method as well. The survival edge may occur because interrupting chest compressions --- even just for rescue breathing-- may further hamper blood flow, and it takes longer to get that blood flow back when it is time for more chest compressions, explains study researcher Bentley J. Bobrow, MD, of the Arizona Department of Health Services in Phoenix."
I'd call that a very reasonable dispute. If you have papers falsifying the hypothesis, please share the links. Otherwise, I think it is reasonable to maintain that there is a dispute over whether blood flow is more important than oxygen injection. You can achieve only both, to the satisfaction of the above hypothesis, if two people are involved (one involved in compressions, one doing the breathing on a periodic basis).
I'm not saying the doctor was right, wrong or purple, only that one of the researchers involved in the study disputes the interpretation that it is solely because of scare factor and that this makes it a significant hypothesis until disproven. It may have been disproven, and if so I'd like to see the evidence, but no amount of pointing to paramedics, St. John's Ambulance, etc, will convince me that a counter-claim by a knowledgeable person was not made and that it should not be taken seriously. Habits die hard and most paramedics were trained prior to 2010, so without actual hard medical evidence I cannot tell from modern practice whether practice is governed by the knowledge now or the knowledge of several decades ago.
Things change, things evolve, but not all practitioners change and evolve with them.
It's a small world and it smells funny; I'd buy another if it wasn't for the money; Take back what I paid (SoM)
The point is that the whole thing is incremental.
If medics didn't try everything to keep patients alive and make them better, they may miss something.
The fact that many doctors, when dying, prefer to simply be left to die only says that, according to their experience and knowledge, their current condition is hopeless and they do not wish to be submitted to those procedures which attempt to keep them alive. Fair enough.
But medical science is (hopefully) improving as time passes. And the patient that was once doomed, may today have a chance to recover.
If the "just let me die" attitude persisted, we'd be defenseless.
Do doctors really need a full 4 years PRE MED?? Cut it to 2.5-3 years and then start med school also pay doctors in residency so they can at least stat paying back loans at the point also make student loans interest free.
Having worked in a morgue, and spent some time with doctors, I find myself constantly surprised how little they can accomplish against a great multitude of diseases, how they can only treat (and not cure) some diseases, and how many of those treatments suck (seriously, many of them are borderline barbaric). On one hand, there are an almost infinite numbers of ways that a human being can die, on the other hand, I'm left scratching my head that some of these doctors don't have a more aggressive approach towards one or two of these diseases. You know what I mean, the "I want to get into the (non-psychiatric) medical textbooks because I made this disease my willing bitch" kind of approach; the "I have some free time Friday, and while I'm drinking or watching a movie, I'm going to check up on how my 'project' is coming along -> googling around to check out the latest research on how the one disease you have it in for is going that week". In the words of Dr. Frank N' Furter -> " I could show you my favorite obsession."
Perhaps more money is being made in the treatment than the cure? Perhaps it's a job program? Perhaps doctors are too overworked to focus on pursing the cure for a disease? Perhaps they've grown complacent? Perhaps the medical schools screen out people with that kind of character flaw?
I am John Hurt.
I worked for a 911 dispatch center (fire / ambulance), and the dispatch software used an Oracle database (for just about every possible event including forms, data processing, timestamps, etc). There was a whole lot to configure when installing, but a lot of control (if 20 ambulances at one end of a city are alll busy, ambulances from non-busy areas shuffle to spread coverage around, etc.). One of the database tables was a 'Do Not Resuscitate' list. It was actually a set of tables that included name/address/age/sex/description/physician(s) and condition(s). For anyone on that list, when dispatched to the address, a flag on the dispatch form would alert the calltaker/dispatcher that the ambulance would not rush, and police would also be sent. CPR would not be performed. I remember looking at the list one afternoon. Most of the people had more than one condition which I would not wish on anyone, and the grand majority had many, eg: Altzheimers, Parkinsons, terminal cancer, and ALS (all in one person). For some, death is a replacement for being unconscious and not in pain, or conscious and in pain. At the apex when still conscious and not in pain (when given a pain med), they would be confused, and not able to move. It was a race between the various diseases as to which would kill them first. My parents are getting older (both 80+). Of their life-long friends that have died, the 'happier' deaths are ones where they went to hospital and died in less than a week or died at home. I had an uncle who was a farmer. He got up to go to the bathroom, looked outside, and when he got back to bed, told my aunt that it was sunny and a good day to harvest the beans (it was 5AM). At 6:00 my aunt realized he had died. It was a heart attack. He died in his sleep looking forward to the day. No doctors, no nurses, no hospitals, no pain. It doesn't get better than that.
Now that the administration is certain they'll become the payor of choice for most people they are testing waters with the propaganda campaign which amounts to "less care is good for you." They actually think that slashdot is "their people." What a bunch of bs.
Any guest worker system is indistinguishable from indentured servitude.
I'm a board-certified physician (among other things). There is no way that I would allow my colleagues to inflict the kind of death on me that they are forced to inflict on so many. Part of this is certainly that I know full well that we all exit this mortal coil toes-up, and there's no getting around it. Part of this is the personal reluctance to experience the diminished autonomy, indignity, pain,and hopelessness that comes with fanatically-treated terminal illness.
But a big part of it, I think, is just that I know that there are so, so many things that are worse than simply dying. Dying in agony, for one. Dying after having bankrupted my wife or my children. Dying after being reduced to a stinking thing in a bed long enough that only those who loved me most even want to be near me, and that only because they feel they must. Physicians see these things all the time, and we see the road that leads to them. We're not (that) stupid, and we would rather exit early on that road, not at its terminus.
As long as I have the capacity for joy I will strive to remain alive to experience that joy. When the capacity - or the joy - is gone for good, I have given quite strict instructions not only to my family but to some other clear-headed and insistent people who will do their best to ensure that I too will be gone without further "heroic" intervention.
The only problem that I have with the article is that it pretends that everyone should make the same decisions. Everyone has their own decisions to make, and without my knowledge and experience I might not make the same ones. I think as physicians we owe it to the people for whom we care to educate as well as we can and help them to understand why we might personally decide one way or another. But I will never tell them how they "ought" to decide - it's really their choice. Taking that choice away from a person leads too easily to very real outcomes that are much nastier than simply a life that ends later than it ought.
According to this book, is not even clear if CPR is useful at all. The only place where CPR is definitely working is in drowning situations and alike.
It is definitely not working in any situation where professional help is more than 20 min away.
If it is useful if help arrives within http://www.temple.edu/tempress/titles/1388_reg.html
But 10-12 years for a kidney? Tell that to a kid with kidney problems. Cripes, tell it to a 40 year old man.
That kid with a kidney problem and 40 year old man have already been told the expected lifetime of a transplanted kidney yet they still choose to go through a major surgery and take immunosuppresive drugs for the lifetime of the transplant in the hope that the kidney will save them from the next 10 years of dialysis. I'm sure they all hope that they will be the exception where the kidney lasts longer, but they are well aware of the risks and expected lifetime of the kidney yet they still choose to go through it - at times asking a loved one to go through a similar operation to donate the kidney.
Pacemakers is a better surgery, but still - 7 years is not enough. Short term fixes.
Granted, it would be better if doctors could repair the heart's natural pacemaker, but as a stand-in, the current artificial pacemaker seems like an excellent fix. I'm not even sure that a longer lifetime is desirable - I don't use my 15 year old cell phone (which was the size of a brick), so why would I want to depend on a 15 year old pacemaker to keep me alive? All it takes to double the lifetime of a pacemaker is put a bigger battery in it.
Newer pacemakers are far smaller than older ones, and they have better features like better in-chest programmability, better monitoring of the heart to decide when to give it a jolt (and how much of a jolt to give), etc. I think a minor surgery every 7 - 10 years is not a bad price to pay to get the latest technology for the device that you literally depend on for your life.
Is there room to improve? Sure, but to imply that doctors are not good at what they do because medical science hasn't come up with permanent fixes for every ailment is a little unfair.
then you'll spend 5 to 10 years drooling and shitting yourself before you die in a diaper.
But compressions are more important than oxygen, so if you have no idea what you are doing, just push down on that chest as fast as you can.
If we could manage to come to grips with this, we could afford universal health care in the U.S. I have seen various figures that show that for most people, the majority of lifetime healthcare expenses are racked up in the last few days of life and that those treatments are largely futile or even actively harmful (in spite of best intentions).
Well I think there is a big difference between some specific version of the oath and the meaning behind it. (Do No Harm)
Personally I think that all Doctors should be legally bound to "Do No Harm".
Troll is not a replacement for I disagree.
Oh, and free education (as per Christ's Hospital in the UK, and universities prior to the abolition of the grant system) produced superior numbers of graduates with superior skills to the education produced by the "free" market of loans and deprivation.
I hadn't noticed this alleged effect myself. My view is that if someone can pay for their education, and pretty much everyone can, then they should.
Compress to the beat of "Staying Alive" by the BeeGees.
His ignorance covered the whole earth like a blanket, and there was hardly a hole in it anywhere. - Mark Twain
I'll take the ten commandments over sharia any day.
Eh, that's sounds pretty anecdotal, doesn't it? Coincidentally, I picked the following article as an example for my statistics class about a month ago: http://jama.ama-assn.org/content/304/13/1447.short
In short: Arizona set up a 5-year program to educate people in CCOPR (chest compression-only CPR). Comparing victims who got CPR from non-medical professional bystanders, to those who got CCOCPR, the latter had almost double the chance of surviving to discharge from a hospital (7.8% to 13.3%). However, when looking at multiple randomized trials for dispatcher-assisted CPR over the phone, there was no statistical difference between the techniques. (P-values 0.18, 0.09, and 0.16; p. 1452-3). The sociology factor is suggested, but it's at the bottom of the list:
"There are multiple reasons COCPR might have advantages over conventional CPR techniques. These include the rapid deterioration of forward blood flow that occurs during even brief disruptions of chest compressions,8,31 the long ramp-up time to return to adequate blood flow after resuming chest compressions, 8,31 the reduction of cardiac venous return with the use of positive pressure ventilation,32 the complexity of conventional CPR,21,33 the significant time required to perform the breaths,28,33,34 the critical importance of cerebral and coronary circulation during arrest,8,31,35,36 the reduced time required for emergency medical dispatchers to instruct a bystander over the telephone how to perform COCPR, 6 and the reluctance to perform mouth-to-mouth ventilation on strangers.25,26,28,37" [p. 1453]
We know where leadership by an anti-intellectual "strongman" who scapegoats minorities and likes boisterous rallies goes
I agree with jd. There are several major studies that have happened in recent years that all point to compressions only being most effective. The first step to achieving this was changing the ratio of compressions to breaths from 15:2 to 30:2. Soon it will be compressions only.
That's not actually quite correct. The current debate isn't about whether hands-only CPR is more effective than full CPR (It's not), the question is whether hands-only is more easily performed correctly than compressions/vents, and is, on average, going to be more effective as it gets performed in the field, add into that the fact that hands-only is easier and faster to teach, and maybe we'll have more of the population able to perform CPR, which means a decrease in time from arrest to start of CPR, which will always improve outcomes.
Actually the current debate is not about the effectiveness per se but about the outcome. Compression only CPR is showing better patient results for lay-people and professionals alike.
http://www.physorg.com/news/2010-10-chest-compression-only-cpr-survival-cardiac.html
http://www.theheart.org/article/1106815.do
And the quality of compressions in compression only CPR goes down over time.
http://www.ncbi.nlm.nih.gov/pubmed/17069958
Why should they? The business and indeed the country profits from the better education far more than the individual. They're ultimately the real customer, the student is merely an instrument of delivery. The customer should pay.
It's a small world and it smells funny; I'd buy another if it wasn't for the money; Take back what I paid (SoM)
Maybe. What I know is I would so much like to deal with the untimely death of G. W. Bush and Obama with their whole cabinets and all but one current republican presidential candidates. Preferably very protracted and painful deaths full of awareness of their inevitability. I think I could deal with it just fine. In fact I would like to witness that.
As a physician, I agree with the article.
Does God treat us as servants or friends? Check my homepage.
Why should they?
I find your subsequent claims disingenuous. The student, not the business or country, is the real customer because they get the benefit and choose what education to consume or not. The business and country don't get to select what form the education takes.
The customer should pay.
And there's your answer once you ignore the bogus rationalizations.
My son has some medical issues and needs close care, but I stay out of the way of his team, and most of them (possibly all of them) don't even know I'm in the health care field.
not a doc myself, but I purposely avoid planting ideas in the doc's head. I figure that being a doc yourself, you might be even more tempted by suggestions.
last time I went, I figured I had condition X, but I didn't say it. I simply described/showed the symptoms (it was indeed X; the condition went away with the appropriate prescription and some behavioral tweaks)
I listen to both RIAA and non-RIAA stuff if I like the music, tangential business/politics nonwithstanding.
to me, "god from a machine" seems to fit. miraculous divine intervention (by writers) to get around a plot issue.
I listen to both RIAA and non-RIAA stuff if I like the music, tangential business/politics nonwithstanding.
This will be one of the few times I'll defend my religious relatives but they are all like the above -- no extraordinary measures, have a cancer/smancer attitude, (my Uncle just died recently -- we watched the mole on his arm for years but he was happy with his 85+ years on this planet and did absolutely nothing about it), etc. And they all go out with memorial services.
I come here for the love
"I distrust those people who know so well what God wants them to do because I notice it always coincides with their own desires."
-Susan B. Anthony
I listen to both RIAA and non-RIAA stuff if I like the music, tangential business/politics nonwithstanding.
maybe it's the sanctity-of-life thing as a condition for entering heaven at all?
I listen to both RIAA and non-RIAA stuff if I like the music, tangential business/politics nonwithstanding.
* Utterly tasteless.
And hence, glorious.
* Perhaps the parent has never had to deal with the death of another human being.
Wrong. The people who deal with death the most are always the most callous and cynical about it.
I'm not sure why this article is even on Slashdot. Is there any evidence supporting this contention that physicians get less care, or is this just a doctor telling us how much better doctors are than everyone else and how we should strive to be like doctors. I've known two doctors who died of cancer in their forties and both went kicking and screaming, taking every last shot medicine would allow and some that had no shot in working and would at best provide days of painful life in a hospital bed. Two isn't a statistically significant sample, but it's more of a sample than Ken Murray gives us.
I think it's likely that Dr. Murray is just making things up in hopes that his patients will chose to die quicker than they currently do.
Support SETI@home
I'm not a doctor, I'm a Physician Assistant and I struggle with this issue quite often. Recently I heard of a middle aged woman who had end stage metastatic cancer. It had impacted her liver and the family asked about a liver transplant in the interest of buying her some additional time. This was not considered a reasonable request, but the family was quite upset about it despite consults with a couple transplant centers. The suffering of the transplant, costs and then immunosuppression would also have been quite expensive. Thankfully her lead physician who is quite a spiritual man spent considerable time with the family and was able to provide comfort. His motto is "that something can always been done." Not necessarily cause suffering but simple comfort care, providing respite for the family, being available to just talk. That is what healing is about.
The comments that are posted are insightful, prgamatic and quite frankly pleasantly surprised me. I'd love to see this message echoed thru the mainstream media i church pulpits and in classrooms. We need to put the focus back on healing and not be so intent on "profitability" which is demeaning to human life and my personal ethics.
I had to deal with caring for my dying parents, whom I loved greatly. Senile dementia is not a nice way to go, and if I'm diagnosed with it I shall suicide without hesitation.
The post was Funny, and my folks (pre-dementia) would have found it amusing too.
Life is for living while living is good, and laughter is part of good living.
"This post is an artistic work of fiction and falsehood. Only a fool would take anything posted here as fact."
Perhaps the parent has and he has learned that death comes to us all, and all that matters is how you lived life and treated others.
Lighten up a bit dude :)
I have cancer. I have faced situations where my death was nearly a certainty. I have lost people both slowly and quickly.
That said, I disagree. I found it terribly amusing. Facing death requires humor in order to make it tolerable.
I've accidentally quit caffeine cold turkey several times (not a big coffee drinker, used it strictly as a stimulant).
I would forget to have my "daily dose" after finishing whatever task that required me to stay awake and alert longer.
I.e. At the beginning of a vacation.
Splitting headaches, muscle and joint pains and generally a zombie-like behavior would last for about two days before I'd get back on my feet.
Switching to green tea, first as a "cool down" stimulant then switching to it completely, I don't have those issues anymore.
Sure, there's still caffeine in the tea but there is far less of it and I never reach my caffeine limit. So, I don't get the "buzz" but I do get the alertness.
Plus, I don't have the issues with dehydration as a decent cup of tea is still mostly water.
And if I want to or have to quit the tea too, i.e. I forget to take it with me to a place where they don't serve it - at worst I'll get a bit drowsy.
Also, I'm told that it's rather healthy.
Granted, if you are used to taking your caffeine through coke instead of coffee it may be harder than simply"deciding to switch".
Particularly in the summer, when most bars/restaurants/coffee shops don't serve tea - but everyone serves Coke. And coffee.
Bonus difficulty points if you are getting most of your supply from a local vending or coffee machine at work.
My solution is to order mineral water instead of coke (unless they serve green tea), and bringing my own supply of tea to work in a thermos bottle.
Mit der Dummheit kämpfen Götter selbst vergebens
Sounds like we need death panels composed of all doctors.
The Usual method of death for us mere mortals is by heart attack or accidents involving cars. The doctors are people placed in direct physical contact with large amounts of contagion. They can choose their own profession of choice.
As a physician, I can't stress enough how true most of this article is. It is important to remember that if you come to me nearly dead and I have no proof that you want to die, it is my obligation to treat you...a lot of futility happens to the unfortunate souls who die alone in life....If you don't decide for yourself how you want to be treated at the end of your life, someone else will (heck, even if you do, someone else still might, but at least it won't be me!).
In the end, it's all the same. We either die of discorporation or asphyxiation.
When you have two EMTs, there is no interruption. One guy does the compressions, whereas another uses an squeezable apparatus (the name escapes me at the moment) to pump air in.
Then you remember that you have knowledge and it is protected with ZFS and scrubbing. Thank God.
Muahaha, priceless. Hooray for FreeBSD :-)
This airplane has been nicknamed "the Doctor Killer".
https://aviatorcollege.wordpress.com/2010/06/25/why-is-the-%E2%80%9Cdoctor-killer%E2%80%9D-airplane-so-dangerous/
Don't take the premise of this article too seriously. Lifespans have increased by about 20 years in the last 40 years. Heart-attack care, for example, is generally an emergency care operation and it's generally not fatal. There is plenty of other examples. Emergency treatment works and works successfully. If it didn't, people wouldn't live as long.
Any guest worker system is indistinguishable from indentured servitude.
Everyone is talking about extended life = suffering at the end, and therefore that we should just accept death.
But what about deep freezing? As someone who isn't religious, this seems to me a good option - ie, satisfying my desire to be able to believe that the end might not really equal oblivion.
Sure, it is almost certainly a false hope and would probably result in a corpsicle that would turn to mush when thawed, but knowing there is a chance of continued existence is better than being certain that's the end, right?
What do people think about this and the practicality of revival hundreds of years later if the odds are beaten?
Please define “harm” for us.
Not being afraid isnt brave; being afraid and going ahead anyway is bravery.
That's why we have the saying that suicide is an act of cowardace.
As a physician, it has always bothered me that the patient's wishes are always conceded to (or the family's), when in some patients CPR is futile, and only helps raise the cost of medical care.
When I was in residency (1985-1990), there was a multi-institutional study that was reported regarding in-hospital CPR. They reported that in patients with terminal illnesses, NONE survived their hospital stay. In patients with terminal illnesses, CPR shouldn't be performed. They're going to die of their disease, and you're not going to do anything about it.
I normally have two-three mugs of near expresso strength coffee a day. Some years ago I went on a two week canoe trip. The guy running the food wasn't a coffee drinker and didn't bring any along. While I missed my sugar fix I had no symptoms of caffeine withdrawal.
At various other times I've been denied coffee for one reason or another. No problem.
I dislike instant coffee enough that when the choice is instant or none, I'll take none.
Like many statements about addiction, take this one with a grain of salt. It's over generalized.
Third Career: Tree Farmer Second Career: Computer Geek First Career: Teacher, Outdoor Instructor, Photographer.
Actually, current theory is that one person doing chest compressions only is better than one person taking breaks from chest compressions to do rescue breathing and/or one person doing chest compressions and breathing wrong, so best to just teach chest compressions in basic first aid.
Compressions and breathing are still better if done correctly by two or more trained para-medicals (meaning anyone with adequate training & experience... industrial first aid people, nurses, care attendants, paramedics, doctors, etc)
What we need is to make regenerative and repair nanotech/biotech research a priority by reducing the worlds bloated, wastefull military budgets adn wars. Aubrey de Grey of the SENS and Mprize research foundations said that 1-billion spent over a 10 year period on current research could eliminate aging in mice, the humans....we waste that much (worlds militaries) in about an hour.....if we spent a weeks worth of miltary $$$$ wastage in say, 1 to 2 years, we could have aging an caners etc eliminated... Some good sites: www.fightaging.org www.mprize.org www.sens.org Books: Ending aging by Aubrey de Grey 100plus by Sonya Arrison Reviewed at: http://mariakonovalenko.wordpress.com/2011/09/20/we-need-more-books-like-100-plus-by-sonia-arrison/
http://blogs.law.harvard.edu/abinazir/2005/05/23/why-you-should-not-go-to-medical-school-a-gleefully-biased-rant/
Slashdot = Sarcasm
Well, yes. (I think I noted myself that traditional CPR could only meet requirements if 2 people were performing it.) The dispute I alluded to was what a single individual (no matter what their background or training) should do, and the linked article would imply that when a single individual performs CPR that there's uncertainty as to whether continuous blood flow is the overriding concern or whether you should mix compression with breathing.
I don't think there's any dispute - at present - that if two people are performing CPR that you should have both (since that should improve the chances of success). I emphasize "at present" because if CPR has as low a success rate as is implied in the original article, then the method may have additional problems. Further studies might well alter the technique even for 2-person CPR. Personally, I think that the stats for CPR are conflated with all the different methods to the point where it's impossible to infer anything about the success rate of doing it properly -- whatever "properly" turns out to actually be.
It's a small world and it smells funny; I'd buy another if it wasn't for the money; Take back what I paid (SoM)
You don't pay for Google, the advertisers do, because the advertisers are the real customers.
And, frankly, I find your elitist view of education to be Medieval at best. Well, no, Christ's Hospital is medieval and offered free education. So that doesn't work.
Corporate? No. Robert Owen demonstrated that mill workers were more profitable when they were given free education and free housing, and that is the basis of the corporate relationship with universities in Britain ever since.
Senile. That seems more appropriate. There is simply no evidence for your assertions, whereas the last 600 years (and the last 3 generations of my own family, myself included) contain ample evidence that mine are indeed correct.
It's a small world and it smells funny; I'd buy another if it wasn't for the money; Take back what I paid (SoM)
Human beings are not "beloved computers," and they are not "porn collections." The comparison, if you want to be pedantic, is a category error.
I didn't think it was funny. Instead, I found it rather insulting. I should have realized that slashdot was full of immature solipsists before bothering to read the comments.
How does a fucking porn collection live and treat others?
I think the general public needs to know that pretty much every patient having chest compression that I've seen being brought into the ER have been dead. That's roughly 0/100. Now if it happens in front of you, a MD, now that's a different story - maybe 30-40% go on and live their lives.
Movies portray CPR, resuscitation, end of life, defibrlllation (the heart "jump start" paddles), etc, in a wholly unrealistic way, and I think it's wrong to continually mislead the public. They have no idea about breaking multiple ribs on the persons chest, electric burns from the defibrillator, brain damage from hypoxia, etc
There may be differences between the above mentioned methods of CPR, but I bet they are trivial, and even more so for the general public.
I'm an oncology surgeon still taking trauma call, and I've seen more than my fair share of death. There are many things we can do to prolong life, but until you, or a loved one gets to that point, then it's hard to say what you will do, and how much you will panic at losing a loved one.
..........FULL STOP.
I'm going to live as long as I can BECAUSE I can. I don't mind the pain. I'm in pain all the time right now. I'll rest when I'm fully dead. Until then, on with the cybernetics!
How do you live and treat others being that serious all the time?
Peace Brother
And, frankly, I find your elitist view of education to be Medieval at best. Well, no, Christ's Hospital is medieval and offered free education. So that doesn't work.
Maybe you should stop having opinions until you can get this fixed? It doesn't seem to be working for you.
Robert Owen demonstrated that mill workers were more profitable when they were given free training
FTFY. The savvy manufacturer knows that a low turnover, highly skilled employee base is most profitable. But how to get that? You get it by having a highly trained and decently paid employee base that can't transfer those skills to another employer with similar pay.
So right away, education is out because it is readily transferable. Similarly, things like free housing don't contribute unless you can somehow provide that housing cheaper than the value of the benefit to the employee. Health benefits are often of the sort of benefit that an employer can get cheaper (with tax consequences taken into account) than the employee. Housing typically isn't.
"Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor."
CPR's great. As long as it's administered within a couple of minutes maximum. Is your 1st aid certificate up to date?
In 1999,I watched my father die and it was horrible. The doctors were less pleasant and more difficult than the undertaker So now the clock is ticking for me and I have a million different things running through my mind, as I read this. Life is so fragile but for me "forever” ended yesterday. I don't drink and I quite doing dope of any kind along with The Marlboro Man well over 20 years ago. I’m not even 60, then in ‘06 my fingernails started 'bluing' and pneumonia put me in the hospital a few times. Its my father's story all over.That ' mild to moderate' COPD has morphed into pulmonary fibrosis and with good care, lots of drugs, compliance and a bit of luck, I’ll live a couple of years. Of course here in the States there's this delusion we have the world's best health care so please don't fuck with it. What a lie.
But of all the shit I learned yesterday, one thing stood out. Doctors don't know everything and given the right scenario, they don't shit. It's magnificent on TV, but when you're the one with the doctor and you ask her" Ok, can we try this and how long have I got?" I watched 5 doctors yesterday, completely flip out when I ask what i considered a rational question considering that these well perfumed and cleaved physicians had just told me my lungs we're rotten. "What do you mean 'you can't fix this' and ' it’s always fatal but you might live 5 even 6 years, maybe into your 80's rubbish."
It had to happen sooner or later and while I might be special, I'm not that special. I always demanded the best from my doctors and that included the straight-up 'don't fuck with me' truth. I got what I asked for and I'm still not happy.
No I am not happy, not at all. I had plans. There was work, more work than ever and that was a lot but I love my work. I wanted to travel some. One of my Doctors died last week and I understand he was a petty, touchy and angry until his demise. He wasn't ready. I can see why he felt screwed. The guy and his partner cleared 4 million each- a year. Dying sucks. Maybe one day we'll tell each other about it, and then maybe we won't. I can tell you this. It’s New Year’s Eve and I’m going to have a 24 ounce ribeye and get loaded.
But 10-12 years for a kidney? Tell that to a kid with kidney problems. Cripes, tell it to a 40 year old man.
Pacemakers is a better surgery, but still - 7 years is not enough. Short term fixes.
My wife is in her 30s and has stage IV cancer. 1.25 years ago, she showed up at the hospital within an inch of her life. The doctors got her patched up well enough to start chemo without her bleeding out of several of her internal organs simultaneously, and then started.
The first month or so was hell, but things improved significantly from there. She handled all her chemo, radiation, and surgery like a champ. She is able to lead a relatively normal life now, except for the fact that she isn't very likely to see 2013, and she sure gets tired easily.
Anyway, we'd be happy for another 10-12, even 7 years. And yes, even at her current comfort level (which admittedly is pretty high, considering). 10-12 years would be a blessing. I know it wouldn't get her anywhere near 90, but, well, we already know she ain't makin' it to 90.
They don't grade fathers, but if your daughter's a stripper, you fucked up. --Chris Rock
After living with systemic sclerosis (Scleroderma) for 33 yrs. A nice quiet death sounds wonderful to me. Three times I have flatlined and against my wishes my well meaning sons have had me brought back to life, I know it is because they fear my death but next time my body says this is it they know that no more bringing me back to this life of pain, loss of all that I once was before my organs have all been filled with fibrosis, I literally am living by sheer faith and hanging on a string to life. But my battle is over and am no longer wanting to go kicking. It is not worth it, only those of us who live long physical lives can say that if I am in a comatose vegetable state PLEASE let me die in peace. My heart goes out to those who do not have an idea what it really is to die...we all have our day and time.
I recommend to those who say they want to live very long lives to go to a convalescent home or nursing skilled facility where I also have spent some months and see the kind of life some of those who are living the LONG lives are actually not enjoying them one bit. Poor dears they are just there all alone waiting for their time, some begging to be put down like a sick animal. Long life doesn't always mean a good quality of life. Just my two cents.
We all cope with loss differently. I cope by using humor - I hope I have the wits about me to be funny to the end.
Also it was a joke, we are allowed to joke about really taboo subjects - it's what makes us human.