oncRN: fyi

i have yet to meet a patient who wants treatment.

patients want an outcome.

big difference.

via oncRN: fyi.

Amen.

I had a patient with an inoperable tumor recently, who’d been getting chemo and radiation for this same tumor for 4 years, while it progressively got bigger and bigger, all nicely documented in the electronic notes.

And, when I advised a hospice admission I was rebuffed.  “The oncologist says we might be admitted to an experimental treatment at MD Anderson”.

I understood their desire to have hope (however misplaced), and wanted to throttle an Oncologist.  We’re talking about a bone invading tumor the size of a soccer ball.  Which has responded to exactly nothing, in  years.  At what point is treatment not only pointless, but counterproductive?

(Old doctor joke: when the nephrologist goes to the morgue to give the last dialysis, they’re surprised to find a note in the empty coffin “gone to chemo”).

We all want to live forever.  None of us will.  Don’t give up when the treatment can give a positive outcome; don’t waste your days chasing treatment when the outcome is more treatment…

thanks to Musings of a Dinosaur for the idea, and OncRN for the insight.


Comments

  1. Interesting, both you and Dinosaur make a statement and then use an anecdote that directly goes against your main point. Then instead of coming to the conclusion that no, some people really are different and want treatment despite minimal effectiveness you postulate some sort of “false consciousness”. What about the “when evidence goes against your theory, maybe your theory is wrong” part of science class?

    Perhaps the concept of “giving up” bothers them more than the chemo. Perhaps the 0.00005% chance of seeing their kid graduate kindergarten is that important to them. Just because they don’t make it all the way through Kubler-Ross’ stages doesn’t mean that they aren’t making the right decision FOR THEM.

  2. Steve Lucas says:

    I watched a friend fight an aggressive cancer and his biggest battle was with the oncologist. She would call his home, talk with his wife, and state:

    “With your insurance and assets you should be in the hospital!”

    There were problems with him getting pain medications because the doctor wanted him in the hospital. At no time was there ever a discussion of extending life and the doctor was very careful to state they only had “treatments.”

    This was a pure money play as a change in hospital structure allowed the oncologist to charge a 20% co-pay at the time of service. My friend knew this, but still had to deal with this issue, along with his rapidly approaching death.

    Steve Lucas

  3. But what do you do when you WANT to believe, and the doc in question says ‘This might help’? You’re certainly not going to say no…. and it’s tough to evaluate the likelihood of a decent outcome when its your own personal body. Time for an Ombudsman MD?

  4. Goatwhacker says:

    I think Bill nails it here. Some physicians are very good at explaining the likelihood of chemo and other treatments working, and for many reasons some are not. Several times I’ve been in the position as a family doctor of having to explain that lung mets, brain mets, etc are a negative prognostic indicator – this is AFTER or during their chemo.

    For all the talk about patient education and informed consent, the biggest factor in what treatments patients choose is still the physician’s recommendation.

  5. The book Super Freakonomics seems to indicate that for most metastatic tumors, chemotherapy is a con came that mainly benefits oncologists and the pharmaceutical companies. Could this be true?

  6. You know, when it’s your dad, and you get to see him hold his three-month-old grandson, those three months you’re buying is important.

  7. I can’t help but laugh that someone used your name in a complaint in an article online about Secrets of the Emergency room. You really got that Troll worked up !!!! Must not have refilled his Vicodin and MS contin for him !!!

  8. This does sound like an obvious money grab. I am amazed that this occurs. Didn’t doctors take the Hippocratic Oath to help the patients over anything else? And how do you discern between a docs ignorance (believing that this is the only way) and a blatant misrepresentation for his bottom line?

    An interesting topic. Thanks.

  9. I’m reminded of a friend who ran an A&E in London and told me it took him a while to get used to the idea that practice makes perfect… sometimes it was necessary to carry on what was futile to ensure techniques were successful when there was the slimmest chance.