HealthDay News – Physicians facing death are less likely to demand aggressive care, according to two research letters published in the Journal of the American Medical Association, a theme issue on death, dying, and end of life.

In the first study, Joel Weissman PhD, deputy director and chief scientific officer of the Center for Surgery and Public Health at Brigham and Women’s Hospital in Boston, and his colleagues reviewed data on Medicare beneficiaries aged 66 or older who died between 2004 and 2011 in Massachusetts, Michigan, Utah, and Vermont. The researchers assessed five measures of end-of-life care intensity during the last six months of the patients’ lives. These included surgery, hospice care, intensive care unit (ICU) admission, death in the hospital, and the cost of care.Compared with the general population, physicians were less likely to die in a hospital (27.9% vs 32%), less likely to have surgery (25.1% vs 27.6%), and less likely to be admitted to the ICU (25.8% vs 27.6%), the researchers found.1

Dr Weissman states,”(this study) seems to confirm the idea that physicians understand the limits of modern medicine at the end of life…when faced with that kind of decision, (physicians) choose to have more peaceful and less aggressive care at end of life”.

In the second study, Saul Blecker MD, an assistant professor of population health at the New York University School of Medicine in New York City, and his colleagues used data from a national mortality survey to compare the location of death for physicians with that of other health care professionals, people with higher education, and the general population. They found that physicians were slightly less likely to die in a hospital than the general population (38.3% vs 40.4%), but equally as likely to die in a hospital as others in health care professions or with similar levels of education. In addition, physicians were the least likely group to die at any sort of care facility: 63.3% for physicians, 65.4% for other health professionals, 66.1%for others with higher education, and 72.4% for all others.2  

“This suggests that being well-educated has an influence on how we experience death,” Dr. Saul Blecker stated.


Summary and Clinical Applicability

When faced with a terminal illness, physicians often opt out of life-prolonging treatment. 

Additionally, it has been shown that healthcare practitioners were also more likely to have discussed end of life care with their caregivers. According to a seminal article in the Journal of the American Geriatrics study,  physicians who had been medical students at Johns Hopkins University found that they were more likely than the general public to have created advance directives, or living wills, outlining specific plans for care if unable to make decisions.3

Reference

1. Weissman JS, Cooper Z, Hyder JA, et al.  End-of-Life Care Intensity for Physicians, Lawyers, and the General Population. JAMA. 2016 Jan 19;315(3):303-5. 

2. Blecker S, Johnson NJ, Altekruse S, Horwitz LI. Association of Occupation as a Physician With Likelihood of Dying in a Hospital. JAMA. 2016;315(3):301-3.

3. Gallo JJ, Straton JB, Klag MJ, et al. Life-Sustaining Treatments: What Do Physicians Want and Do They Express Their Wishes to Others? Journal of the American Geriatrics Society, 2003 51: 961–969.