On point, thank you Dr. Chakraborty. As a general internist over the years, I had many occasions to question the wisdom of aggressive therapeutic interventions unlikely to benefit patients near the end of life, not just cancer but heart disease, neurodegenerative disorders along with frailty and advanced age. These are tough decisions,…
On point, thank you Dr. Chakraborty. As a general internist over the years, I had many occasions to question the wisdom of aggressive therapeutic interventions unlikely to benefit patients near the end of life, not just cancer but heart disease, neurodegenerative disorders along with frailty and advanced age. These are tough decisions, maybe the toughest for patients, but we often fail to help our patients adequately weigh the pros and cons just as you explain. It's common, as we all know.
An extreme example. I had a 98 year old gentleman present with a nearly completely obstructing advanced aggressive unresectable cancer of the distal rectum and anal canal. I met with the patient and his wife, recommended a diverting colostomy followed by palliative care, a plan of care shared by his gastroenterologist who had made the diagnosis. The colorectal surgeon to whom he was referred disagreed and referred the patient to a radiation oncologist who recommended a course of radiation therapy. While in the hospital, on day two of his XRT, his colon perforated, he became septic and died.
I had a cardiologist colleague who once when we were discussing a chronically ill mutual patient who had died following a high risk intervention, a decision that in retrospect he questioned, commented, "we killed him so he wouldn't die." We are all, patients, loved ones, physicians, subject to heuristics that bias our better judgement.
On point, thank you Dr. Chakraborty. As a general internist over the years, I had many occasions to question the wisdom of aggressive therapeutic interventions unlikely to benefit patients near the end of life, not just cancer but heart disease, neurodegenerative disorders along with frailty and advanced age. These are tough decisions, maybe the toughest for patients, but we often fail to help our patients adequately weigh the pros and cons just as you explain. It's common, as we all know.
An extreme example. I had a 98 year old gentleman present with a nearly completely obstructing advanced aggressive unresectable cancer of the distal rectum and anal canal. I met with the patient and his wife, recommended a diverting colostomy followed by palliative care, a plan of care shared by his gastroenterologist who had made the diagnosis. The colorectal surgeon to whom he was referred disagreed and referred the patient to a radiation oncologist who recommended a course of radiation therapy. While in the hospital, on day two of his XRT, his colon perforated, he became septic and died.
I had a cardiologist colleague who once when we were discussing a chronically ill mutual patient who had died following a high risk intervention, a decision that in retrospect he questioned, commented, "we killed him so he wouldn't die." We are all, patients, loved ones, physicians, subject to heuristics that bias our better judgement.
Thanks for sharing your experience. We all struggle with these decisions.