Many Doctors Choose End-of-Life Care Differently Than the General Population, Two Studies Show
Two studies in JAMA provide insight on how doctors face end-of-life care.
— -- The way many doctors face end-of-life care differs from the approach of the general public, according to two new studies published today that suggest doctors are actually less inclined to seek heroic medical care in those circumstances.
In the first study, researchers found that physicians were slightly less likely to die in a hospital, get surgery shortly before their death or be admitted to the intensive care unit compared with the general population. The study used Medicare data to look at the treatment of 670,056 people -- 2,396 of them physicians -- shortly before their deaths.
The study, published today in the Journal of the American Medical Association, found that about 28 percent of physicians die in hospitals compared to 32 percent of the general population, and approximately 25 percent have surgery compared to more than 27 percent of the general population. The study also found that about 26 percent of doctors are admitted to the ICU compared to about 28 percent of the general population.
Dr. Joel Weismann, lead author of the study and deputy director and chief scientific officer of the Center for Surgery and Public Health at Brigham and Women's Hospital in Boston, said the data shows a clear trend that physicians in general get less medical care at the end of their lives.
One reason may be that doctors understand extra procedures do not always mean better quality of life, he said.
"They experience death on an almost daily basis," Weismann told ABC News today. Extra procedures are "not always what people want."
He pointed out that doctors realize modern medicine can both help or harm people, depending on their overall condition.
The second study looked at data from the U.S. Census Bureau and also found that physicians were less likely to die in a medical facility than the general population. The study, also published in JAMA today, looked at 411,243 people, including 815 physicians and 2,635 people in the health profession who were not doctors and 15,308 other people with higher education.
Physicians were the least likely of any group to die in hospital or medical facility, with just over 63 percent of physician deaths in a medical facility compared to 65.4 percent for other health professionals, just over 66 percent for people with a higher education and 72.4 percent for the rest of the group.
Barbara Daly, a bioethicist and director of clinical ethics at University Hospitals Case Medical Center in Cleveland, said people are generally not well-prepared for difficult decisions they or their families may have to make during end-of-life care and that doctors may prepare for this inevitability more easily.
"It's a national concern about the quality of people's lives at the end of their life, and a perception that the health system is providing more aggressive care ... than is effective," Daly said.
Doctors have more experience seeing what truly happens in the ICU, Daly noted, and seeing the effects of invasive procedures may color what they want for their own end-of-life care.
"In many cases, we're not saving lives -- we're prolonging dying," Daly told ABC News. "Most people would choose to be in their own home during their death."
The goal should be to have people talk more about end-of-life issues long before they get to the hospital, she said, noting that people don't need inside knowledge of an ICU, but rather need to make a decision about what is important to them in their life. If it's saying out a nursing home or not having to rely on any life-extending equipment, that will help them make difficult decisions.
Dr. Bhavini Murthy, a resident in the ABC News Medical Unit, contributed to this report. She is a preventive medicine resident physician at the University of North Carolina at Chapel Hill.