Putting Down Pets And People

I read a very poignant post by Neo-Conduit this morning about her terminally-ill friend who considered suicide. I was reminded of a question I have often been asked by patients:

We put down our dying pets humanely. Why can't we be so good to people in the same situation?

It is a good question that needs an answer. Doctor D used to just say, "Doctors shouldn't kill patients," but that really didn't respond to the suffering of people facing terminal illness.

I am glad that euthanasia is illegal where I work. Doctors have the ability to keep a dying person comfortable without putting them down like dogs. Human beings are not dogs. Doctor D was good to his elderly dog when he euthanized her, but there is a huge difference between killing a pet and a person.

The most important approach to suffering people is a deep respect for their value as human beings. That respect motivates me to care for their pain. It motivates me stop treatments when they no longer desire them. It also motives me to never give a deadly medicine—even if it is requested.

The approach of death can be disorienting and terrifying. There is a spiritual suffering that is often greater than any physical pain. In moments of hopelessness ending one's own life may seem like the only escape. A person asks him or herself, "What is the value of this dying thing that is me?"

Doctor D has had many patients nearing the end of life say to him, "I wish I could die now!" I have yet to have a single one be disappointed when I respond, "It is ethically wrong for me to end your life, but I will stay with you till the last breath and make sure you are comfortable and respected."

Suffering and dying people need to know they have some value that is more than the sum of days they have left. The deepest respect of all is reminding them they have the most valuable thing of all: a human soul.

Quality of Life is a subjective judgment. I honor my patients by letting them decide what is a quality life and what is not. Value of a Life is different. The value of every person's life is infinite. I honor that value by never killing a human being for any reason.

I already know Nurse K is going to give me a hard time for such a touchy-feely post. Doctor D promises to get back to some fun shit soon.

...But before we get back to fun questions what do you think of Euthanasia?

Who Determines Quality Of Life?

This is an interesting question Doctor D found in a discussion going on at the Serenity Now Hospital blog.

Quality of Life is the concept that medical care should focus not just on the number of days our patients live but the amount of meaningful and fulfilling health within those days. Patients will often sacrifice length of life for improved quality of life. Some patients also decide that in the face of a life-threatening illness they will not have further treatment once their quality of life falls below a certain level.

Reflecting on quality of life helps doctors recognize the humanity of their patients. It helps us realize that that longer life isn't always better. At its best, quality of life allows the patient to decide how they approach illness and disability, while the doctors respectfully relinquish control to the patient's wishes.

Doctor D believes that quality of life cannot be determined apart from the patient's personal values and preferences. Many doctors, however, make quality of life judgements about their patients. Often physicians embrace the concept of quality of life without acknowledging that it is a personal decision that belongs to the patient not them.

On the post "Compassionate Death?" Doc Sensitive relates the story of an attending that decided not to treat an elderly man with dementia due to the attending's belief the man had no quality of life. The attending allowed the patient to die comfortably and untreated without ever trying to find out the old man's desires or contact the man's family. Doc Sensitive wonders if this was the right way to handle this patient?

The discussion after the post is also interesting. (Doctor D threw his 2 cents worth into the conversation too--It's the 3rd comment down.)

What do you think? Would you be comfortable with a doctor making a quality of life decision for you if you couldn't speak for yourself? Do you think Doctors are the right people to be making quality of life decisions? Do accounts like this make you more likely to get a living will or discuss your wishes with your family?

Doctor D will be back soon with more answers to your questions.

Why Would Anyone Ration Healthcare?

You want to know why?

Once upon a time Doctor D was in an Emergency Room. A patient came in by ambulance:

What was the patient's emergency? Dry hands from washing dishes! Why did the patient think this was an emergency? They hurt! Why did the patient come by ambulance? The car was broken down!

The total cost of an ride in a fully-equipped ambulance and a room in a fully-staffed emergency room must have been well in the thousands, which means that Doctor D holds the world record for most expensive tube of Vaseline ever given.

Guess whose insurance premiums and taxes go up when this happens? Everyone!

This patient's healthcare needed serious rationing!

Can you help me with my Doctor-Patient Relationship?

Yes! That's actually why I started this blog.

Think of me as the relational therapist for your doctor-patient relationship! Heck, you can use me as your counselor for your relationship with the medical system in general. Doctor-patient relationships can be full of miscommunication, mistrust, unspoken expectations, and emotional baggage from past relationships. This kind of stuff dooms romances all the time, but when it messes up your medical care it might significantly damage your health.

To make things worse a lot of doctor-patient relationships are arranged marriages (by insurance companies) or random couplings (the doctor that is on-call the day you need care). You may prefer to stay single, but sooner or later you'll need one of those jerk doctors and Boom! ...you are in a relationship. As Doctor D's wife can attest, relationships with doctors can be tricky!

While he is an excellent physician, Doctor D cannot be your personal physician over the Internet. Long distance relationships just don't work out for him. But he is offering to be that guy that understands both you and your significant other and gives some sage advice.

Is Doctor D doing this out of the goodness of his heart or because he is a glutton for punishment? He doesn't know either. Perhaps Doctor D should see a therapist about this, but until then send in those questions!

E-mail Doctor D

How Could Diets Cause Obesity?

Diets with "results" make you drop pounds quickly, which is not always a good thing. Human bodies have very strong instincts to prevent death from starvation. Throughout the ages these instincts have saved a lot of lives. Now for the first time in history lots of people are dying due to obesity. Your instincts weren't designed to save you from fat.

So what happens when you go on one of these diets? All those amazing diet plans you hear about cause your body to dip into it's fat reserves. This triggers some very powerful survival reflexes. Your body drops its metabolic rate drastically. Your mind unconsciously scans your environment for high-calorie foods to save you from starvation. Your body starts finding shortcuts to avoid burning calories. All this is great if you really are trying to survive a famine, but not so good for dieters.

Think of these instincts like a hibernating angry bear. Don't waking up that bear!

Most of us cannot realistically stay on these crash diets the rest of our lives, but the starvation defense mechanisms keep running strong long after the diet is over—sometimes for the rest of you life. It is only the very rare patient I've seen keep their new low weight. A vast majority rise far above their pre-diet weight in a few years. They might have liked how they looked for a trip to the beach, but their overall health ends up much worse, which often pushes them to even more drastic diets. What may have started as a mildly overweight person ends up morbidly obese over a couple diets.

Doctor D has seen it over and over again, so consider yourself warned!

Sorry to ruin your hopes of becoming a swimsuit model, but those dieting books and quick weight loss shows will make you miserable in the end.

Why Are Americans So Fat?

Excellent Question! The "Obesity Epidemic" has been getting a lot of press recently. Americans are too big and getting bigger. Being very overweight seriously raises your chances of all sorts of miserable problems including having to see doctors like me more often.

There are lots of theories for why we are fatter than any other time in human history. Doctor D is a bit concerned that no one is talking about a potentially deadly cause of this trend. Here is Doctor D's unscientific theory of why so many of us are so fat:

Dieting makes people fat!

Think about it, how many people on diets loose weight only to gain back every pound plus some? Everyone believes dieting is wonderful because obesity is bad, but what if diets are making the problem worse? There have always been heavy people, but so many people who get heavier indefinitely till it kills them is a recent problem. People keep getting heavier because they keep dieting.

Stop it now, before you get even bigger. And whatever you do, do not watch “Biggest Loser.” That show is a public health threat. I'm serious!

(Tune in next time to learn why dieting causes obesity.)

Why Are Doctors Such Jerks?

Let's start with a question I know that you have been wanting to ask:

Why are so many doctors jerks?

Excellent question! As any nurse will tell you, doctors are notoriously difficult to work with. We doctors have a much higher percentage of jerks among us than the general population. Even Doctor D (on very rare occasions) has been known to be downright ornery towards patients. There is a epidemic of condescending, difficult, foul-tempered doctors, and you the patient are the one who suffers!

Some doctors have been jerks their whole lives. Maybe they weren't hugged enough as babies. These docs just love having a position of power so they can make others feel small. Such natural-born jerks can be found in any profession, and just one of them (especially as a customer service representative) can make anyone's day miserable. Such doctors will never change. It is best to avoid them whenever possible (unless you need surgery).

But the relatively few natural-born jerks in the world just aren't enough to explain the over-abundance of jerk doctors. This only leaves one explanation: many doctors become jerks by becoming doctors.

The number one reason everyone says they want to go to medical school is "to help people." Believe it or not, we were all once innocent wide-eyed young medical students who really cared about you.

Then they fed us through the decade long meat-grinder of training involving sleep deprivation, endless memorization, calling patients by their diseases, and getting yelled at regularly by our jerk-doctor teachers. At first we hated those other jerk-doctors, then we felt sorry for them. We worked till we were dead tired, and then got told heathcare is cutting back so we had to do the same work twice as fast next time. Patients expect us to work miracles after watching too much TV, and don't see any reason for dieting or quitting smoking since our purpose in life is to cure everything. Despite our good intentions people keep destroying themselves with bad habits, and nice people keep dying, and everyone is angry we can't turn them back into twenty-year-olds. Add to that lawyers promising irritated patients that they can hit the jackpot, if they just sue jerk doctors--It is enough to turn even the nicest medical students into misanthropic bastards.

As a patient that just wants to get your check-up none of this is your fault, but you are going to bear the brunt of this. Your best bet is to look at your doctor, and try to imagine him/her as the kindly, altruistic, and terrified student that showed up on that first day of medical school. Somewhere in your doctor lurks that annoying humanitarian impulse that doesn't die easy.

Look your doctor straight in the eye and say, "Doc, I really appreciate you taking care of me." Only say this and nothing else! Under no circumstances then ask for something or launch into a list of every odd symptom you had in the last year. Just say something nice and leave. A jerk-doctor hasn't seen human kindness and generosity in years might just feel a warm spark of caring in his/her cold heart. Doctors have a bad habit of forgetting we work on real people. Suddenly you become a real person and not just a patient. Trust me, doctors actually care about real people. You just have to remind your doctor that real people exist.

Who knows, your doctor might even be nice to the nurses after seeing you?

Any Questions?

Okay I'll Ask Some Questions

No one is asking questions! But that is probably because you don't know this blog exists yet, so your lack of participation is forgiven.

I will start by asking questions I know you're wanting to ask...