Reply to Comment on: How U.S. Doctors Die: A Cohort Study of Healthcare Use at the End of Life.
Reply to Comment on: How U.S. Doctors Die: A Cohort Study of Healthcare Use at the End of Life.
复制标题
回复评论：美国医生如何死亡：临终医疗保健使用的队列研究。
DOI：
10.1111/jgs.14928
复制
发表时间：
2017
影响因子：
6.3
通讯作者：
Matlock,DanD
中科院分区：
文献类型：
--
作者：
Fischer,StacyM;Matlock,DanD
非常感谢您对我们的手稿《美国医生如何死亡：关于临终时医疗保健使用的队列研究》(1，2)的深思熟虑和挑衅性的评论。诚然，我们预计会发现，医生使用的重症治疗(如住院和ICU护理)较少，而更注重舒适的护理(如临终关怀)。我们假设这一点是因为来自医生的调查数据的一致发现表明，绝大多数人宁愿放弃许多这些在生命末期延长侵入性治疗的密集生命。然而，我们发现医生住院的频率与非内科医生相同，使用ICU的时间略长于非内科医生。与非内科医生相比，他们使用临终关怀的频率和时间也稍长一些。我们对我们的发现提出了可能的解释，包括我们没有人能幸免于对自己死亡的恐惧。然而，在你们的讨论中，我认为你们强调了一个重要的事实，这个事实可能也在推动我们的发现。通过时间、艺术和文学，我们自己有限的存在的不变性和普遍性，以及一个正在走向不朽的社会的压力。因此，我们努力在生命的尽头找到和平、爱和免于痛苦的自由，而这个系统通过机器和技术悬挂着更多时间的承诺，这些机器和技术推动了垂死的人的边缘化。因此，我们可能会选择一次类似于西西弗斯的旅程，将他的巨石滚上山，结果却看到它又滚了下来。我们与患者交谈，了解他们的目标和价值观，并帮助他们将目标和价值观与可能的医疗保健相匹配。我们与我们的同事交谈，提醒他们，有时争取尊严和生活质量的斗争与延长生命的斗争一样重要和有效。我们进行的研究试图强调，我们所服务的系统默认为许多人在生命末期提供高成本、低价值的护理。
Thank you so much for your thoughtful and provocative commentary about our manuscript,“How US Doctors Die: A Cohort Study of Healthcare Use at the End of Life”(1, 2). It is true, we expected to find that doctors used fewer intensive treatments (such as hospital admission and ICU care) and more comfort focused care (such as hospice). We hypothesized this because of the consistent findings of survey data from doctors state that an overwhelming majority would prefer to forgo many of these intensive life prolonging invasive therapies at the end of life. However, we found that doctors were hospitalized just as often and used the ICU slightly longer than their non-physician counterparts. They also used hospice a little more often and a little longer than the non-physicians. We propose possible explanations for our findings, including that none of us are immune to the fears of our own mortality.However, in your discussion I think you highlight an important truth that may also be driving our findings. The immutability and universality, through time, art and literature, of our own finite existence and the pressures of a society driving towards immortality. And so we struggle to find peace, love, and freedom from suffering at the end of life, while the system dangles the promise of more time through machines and technology that drive the marginalization of the dying. Therefore, we may choose a journey akin to that of Sisyphus, rolling his giant boulder up the hill only to see it roll back down. We talk with patientsunderstand their goals and values and help them match that to the medical care that is possible. We talk with our colleagues and remind them that sometimes the fight for dignity and quality of life is just as important and valid as the fight for prolonging life. And we conduct research that attempts to highlight that we are serving a system that offers as its default high cost low value care for so many at the end of life.