Physicians Learning About Law and Its Application at End-of-Life

Professor Sawicki writing a guest post at HealthLawProfBlog. “How Medicine Learns About the Law” offers insight into medicine and law. Specifically she speaks to malpractice and end-of-life. 

  • Physicians learn about law from friends, message board, media screaming heads. 
  • Physicians enter into medicine as Sawicki says ’scared straight’ fear driven.
  • Medical professionals fear of liability is unfounded. Though all physicians fear being sued. A 2011 NEJM study showed 75% to 99% of physicians had faced a malpractice claim by age 65. Sawicki points out engineers and architects face the same statistic. 

it’s important that medical providers have a more realistic perspective of how likely lawsuits against them are to succeed

Sawicki addresses areas within my wheelhouse, end-of-life and advance directive. She points out that physicians are pressured from families to over treat a no-longer competent patient even with an advance directive requesting no treatment. Why? Being sued. In her research she states:

… have not yet found a successful suit by a family against a physician for non-treatment in compliance with a patient’s prior wishes.

This struck me because there have been reports and articles that saw this differently: only 12% of patients with an AD received input from their physician and “65% to 76% of physicians with patients having completed an AD were not aware it existed. And the providers, family members, and surrogates did not meet the patient’s wishes for EOL management.” 

Other articles point to how physicians were only 65% accurate in predicting patient preferences and tended to make errors of under-treatment even following a review of the advance directive.

Professor Sawicki makes the point, the right result medically is the right result legally. What is medically right at end-of-life is the patient having their wishes met. Those wishes need to be set in place well before end-of-life and with an advance directive as well as identifying a trusted respected advocate. Carolyn and I spoke about this in Podcast #5 Advance Directive

Both the law and medicine need to step away from the crushing media bullshit on malpractice change and focus on patient wishes at end-of-life. We need to ensure patient wishes are patient reality.  

You Talking to Me? Language and End-of-Life

Bridget Sumser, LMSW writing in has a short yet powerful post titled “The Importance of Language”.

Sumser addresses the idea that language used to communicate with patients and caregivers struggling with depression can have a therapeutic power. She uses a powerful though all to communal example:

Question: What’s her (the patient’s) code status?
Answer: “She is a DNR”

You see it as well? She is not Marge or Jane. She is DNR. What struck me is not the obvious the act through language of taking a person and reducing them to a behavior or action. What was interesting is how language, which we all know, drives message, sent message message received. What do individuals hear with the words we use?

I am not going to deconstruct the couple arguing over he said she said and how one word in a statement or comment or observation can evoke a response. How we communicate especially around the topic of palliative care, hospice, end-of-life makes all the difference in the uptake of knowledge and understanding especially if we are advocating to those who have not experienced any of these. Those who live in the echo chamber of end-of-life and have been touched by it with a loved one do not readily reject language or miss meaning since we share a common vocabulary. But our online voice and though chats, blogs, etc. reach those who are not familiar or share our common bond. Therefore language, words, and images drive meaning, understanding, and uptake.

In The Sun Magazine interviewed Katy Butler. Butler is a journalist and novelist who wrote about her fathers stroke and how modern medicine decreased his chances of a good death. “The Long Goodbye” is that interview which you can read.

Butler in her interview uses language to communicate her points very well and I see those words and images as tools we can use to communicate beyond the echo chamber we reside in online. Here are some examples that speak to our message and may connect better with those who do not share our experiences.

“Death used to be a spiritual ordeal: not it’s a technological flailing. We’ve taken a domestic and religious event, in which the most important factor was the dying person’s state of mind, and moved it into th hospital and mechanized it, ..”

“…when we eliminated sudden death death, we also eliminated natural death, and we lost the distinction between saving a life and prolonging a dying.”

“We’re not isolated atoms in space — at least, that’s the way I see it as a Buddhist. We’re part of a web of existence, and the “patient” is not just the patient but the family that will survive him.”

“If you’re a doctor, I think you have to look at whether you’re adding suffering to the family as a whole when you extend the life of an individual.”

These are some examples that connected with me and believe will connect with others facing end-of-life or earlier when they have a diagnosis that will end in death. Those are powerful images from Butler’s interview and the narrative about her father and mother. These are the messages we can use to communicate and use as discussion points when we write or speak on these topics. I am not dictating one message over another, her words vs. your words, vs. my words just that the broader and more expansive our vocabulary the better the chance we have to send a message that is received. Of course our listeners our audiences need to be receptive to learning but that is an entire separate discussion on adult learning. 

For me there is no good death. All death sucks. What we can do is advocate for and try to achieve a good dying so everyone involved is present and active in life and family during that time. 

Yet Again The French Offer the World Some Health Lessons

Beck, Richard, Nguyen-Thanh, et. al published “Use of the Internet as a Health Information Resource Among French Young Adults: From a Nationally Representative Survey” in the Journal of Medical Internet Research. 

The objectives 
(1) to provide information about the prevalence of Internet use for health-related purposes in France among young adults and define the sociodemographic, socioeconomic, and health-related profile of users, (2) to investigate the context and the impact of the information found on health-related behaviors, and (3) to assess the level of trust young adults have in the information found on the Internet.

This study was done in 2010 and surveyed 27,653 individuals in France. 

  • 48.5% (474/977) of Web users aged 15-30 years used the Internet for health purposes
  • Those not using the Internet for health purposed 75% reported information from other sources, 74.1% preferred seeing a physicians, 67.2% did not trust the information on the Internet.
  • 80% (371/474) young online health seekers considered information found online reliable. 
  • Women, individuals with higher sociocultural positions and individuals with executive or manager positions were more likely to use the Internet vs. employees and manual workers.
  • Women with children experiencing psychological distress participated in online health seeking. 
  • Online health seekers aged 15-30 years 33.3% reported they changed their health behaviors (e.g. frequency of medical consults, way of taking care of one’s health) because of online searches. 
  • The most common factors associated with different outcomes of change were psychological distress, poor quality of life, and low income. 

None of this is significantly new to those of us in the echo chamber of social media, epatients, blogging, etc. Yet this study demonstrates that the young will use the Internet, they trust it, and they will change behaviors. Clearly they have grown up online. They are not estranged from the Internet and embrace it. This group will likely be seen by physicians of similar ages so the patient and the physician share a common trust of the Internet for health seeking knowledge. 

This bodes well for healthcare going forward. As this group ages and faces illnesses they will have the tools and knowledge to find information and they will have the support of their physician. Those two factors alone will drive sea change in healthcare. We must cultivate and grow this trend.