What We Can Learn From How Doctors Choose to Die   (January 11, 2012)

We can understand the systemic flaws in the U.S. "healthcare"/sickcare system by examining how doctors choose to die, which is quite different from the experience of their patients.

Explaining how the U.S. "healthcare" complex is actually a sickcare system is a major theme of this site. Promoting health via lifestyle, diet and fitness is essentially profitless (the equivalent of selling raw carrots) while treating illness, especially chronic illness, is immensely profitable (the equivalent of selling burgers, fries and soda).

The U.S. sickcare system is a partnership of private-sector cartels and the Central State, which diverts 18% of the national income to the cartels.

Sickcare has a wealth of perverse consequences, including "defensive medicine" practiced to avoid malpractice lawsuits, unneeded care provided to increase profit margins, unnecessary procedures and tests, dangerous medications of limited efficacy, massive systemic fraud in the government sickcare programs, and on and on.

But perhaps the most perverse consequence is the needless suffering the system imposes on its patients under the guiding principle of "doing everything we can to prolong your life."

If I had to describe the core beliefs that power oftwominds.com, one would be that health is ultimately the only true wealth, and that roughly 2/3 of our health is in our hands-- the other third being heredity and environmental factors outside our influence. Any situation in which we control 2/3 of the outcome is significant, as many situations in life only allow a limited response to events outside our influence.

Despite this extremely meaningful level of influence, few people actively seek to improve their health until they experience a "wake-up call" such as cancer or a near-death encounter via a heart attack. Waiting until one's health is already severely compromised before taking action invites a negative outcome, but even this "obvious" reality does not persuade people to start consistently doing all the things we're constantly hectored to do: lose weight, start exercising, etc.

It is remarkable how vulnerable we are to faddish "easy fixes" (drinking coconut water being one of the latest incarnations of the fad fix) and how resistant we are to the one proven "miracle cure": exercise.

Given my focus on health and the perverse sickcare system, I read the following article with deep interest. I am indebted to longtime correspondent Joel M. for forwarding it to me: How Doctors Die by Ken Murray M.D.

"Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patientís five-year-survival oddsófrom 5 percent to 15 percentóalbeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didnít spend much on him.

Itís not a frequent topic of discussion, but doctors die, too. And they donít die like the rest of us. Whatís unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently."

I sent this to longtime correspondent Dr. "Ishabaka" (a U.S. physician with decades of experience) and his response is revealing:

"That is the best article I have read in a long time, and I AGREE WITH EVERY SINGLE WORD. I have a living will and an advanced health care directive. There's a bright red card in my wallet with this on it (if you come in the ER unconscious or confused your wallet gets checked). I've told my wife that if I'm badly injured in a car crash but can be fixed up, to have me admitted to the ICU and tortured (the ICU is really a torture chamber). If I have terminal cancer, I would refuse chemotherapy for all but a few types that respond well to it (most don't). I want to stay a home, with a hospice nurse if necessary, and die in my bed.

By the way, the Feds passed a law saying doctors HAVE to do everything if the patient is mentally incapable of deciding for themselves, unless the patient has a living will, advanced health care directive - or a family member or other adult appointed as legal guardian (which will NOT be the case in the example the author gave - sudden unconsciousness due to massive stroke). This was done during my career. I used to be able to have a sit-down with the family and decide whether or not to "do everything" when, say, someone with documented terminal cancer came in with some near-death condition and was "out of it".

Now, that's illegal, and I could get into enormous trouble - it's insane! Here is exactly what could have been done to me: a $50,000 fine and loss of the ability to bill Medicare for five years. As an emergency physician that would have put me out of business, as Medicare is one of the main sources of income for emergency physicians."

I think these accounts make it clear that each of us has a responsibility to our families to get a living will or advanced health care directive, and make sure those close to us know about it and where to find it. We also need to make sure our elderly loved ones have stipulated their wishes, and that we know where these documents are located. Otherwise, what happens to them in a medical emergency is out of our hands.

Amongst the thousands of emails I receive annually, a handful mention that the site provided some inspiration and/or information on improving diet and fitness and on sustainably losing weight. For example, a longtime reader recently mentioned losing 30 pounds after reading these articles I posted in 2010 (via correspondent Ken R.) by a physicist on gluttony and weight loss:

The Physics Diet

On Gluttony

Basically, it comes down to eating less, eating better food, building/maintaining muscle mass and doing some aerobic exercise that gets your respiratory rate up. That's it. Nothing fancy.

Humans are famously inept at long-term planning, as that skill offers limited selective advantages in a hunter-gatherer lifestyle where food is gathered daily and the group often traveled daily. Thus is is "natural" to continue living at 50 the same way we lived at 25, when our bodies could tolerate excess and poor fitness.

It is also tempting to focus on the 1/3 of our health we don't directly control and become passive about what happens to us.

I view eating real food and daily stretching and exercise as "paying myself first," the idea that one saves money/accumulates capital by paying oneself first and then paying the rest of one's obligations. The typical American household pays all their bills and fulfills their gratifications and intends to save what's left. Alas, there is rarely much left when you "pay yourself last." In the same way, people pay themselves last in fitness and eating better, too, with the same results--nothing changes sustainably.

This is not an abstract topic in my view, as I anticipate the sickcare system devolving in the decade ahead. Since this site has many correspondents who are doctors and nurses, I know how close many care providers are to walking away from this sick system. The average patient has no idea of the burdens and risks carried by many care providers; they only hear about the big salaries. But the system is dangerously close to breaking the will and spirit of those tasked with operating within it. If you think this is far-fetched, you don't know many practicing doctors and nurses.

I think it highly likely we will need cash to get care, and various elements of care may be scarce at any price. Cash (or equivalents) may well be king, but no amount of money can restore health once it has been lost or squandered. In pondering the end of life, hopefully we can draw inspiration to change our lives, diet and fitness in the here and now to preserve and improve what health we currently possess.

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