A Situation With Doctors Which Has Incurred My Wrath.

The BBQ Pit
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Pardon me for not following pitequette and swearing, but I’m so angry that I have gone through swearing and out the other side.

My grandmother is nearly 90 years old (she’ll be 90 in October). Against the advice of some smarmy young twerp 10 years ago, she had a quadruple bypass. (His ‘advice’:“Really, I don’t know that it’ll improve your quality of life, it’ll just prolong things”. I’ll translate what he meant: “You’re old, and it may not work, so why bother?”. Trust me. From his tone of voice, his intent was clear to all people present, including a nurse, who, after he left, called him a “prick”. Clearly an intelligent and perceptive woman. Besides, isn’t ‘prolonging things the whole point?’) He was wrong, of course: by having the surgery, she got 10 more wonderful years wherein among other things, she got to see her great-grandkids (and they’ve had the experience of knowing her.)

She’s been doing less well recently. She has been taken to the hospital with chest pains and fluid in the lungs several times. Thursday she was taken to the hospital again and after consulting with a cardiologist (not her regular one, who wasn’t available this weekend: I think he was out of state), it was determined that a pacemaker might improve the situation. I felt that this was handled very well, and the cardiologist offered her the pros and cons of a pacemaker given her situation (it could give her another 3+ years, surgery has risks, it doesn’t guarantee that she’ll feel better much of the time, etc) and let her make the decision. Well done. After much discussion, evaluating and stress, she chose to have the proceedure figuring the risk was worth the possible gain (per the cardiologist, she has maybe 6-10 months if she doesn’t).

She was moved to another hospital where the surgery would take place and some doctor (not a cardiologist)comes in, looks at her chart and says “Why are they going to give you a pacemaker? I don’t think it’ll improve the qualitity of your life any.” This is at 9:30 at night, after the family has left for the evening, right before my grandma’s going to sleep.

Now my grandma is extremly upset. She doesn’t realize that “quality of life” means, risky, expensive and ‘you’re old, why bother?’) She’s scared (justifiably) that the no one knows what they’re doing. She’s being forced to reevaluate the whole proceedure again, because some overpaid twerpette thinks that she knows better than my grandma, what factors make her life have ‘quality’.

There is a trend that I’ve noticed over the last 10 years or so: Doctors think that they’re something more than glorified auto-mechanics. That they’re ‘spiritual counsillers’. That they will offer ‘wellness in all areas of your life’ (what arrogance to think they’re welcome in ‘all areas of my life’). That they’re qualified to judge issues regarding “qualitity of life”. Exactly ONE** person is able to judge that, the individual who’s life it is.

I am going down to the hospital this afternoon to talk with the cardiologist and my grandma and help her come to a decision (again). And I can’t wait to run into the twerpette. If she uses the ‘quality of life’ phrase in my presence she’s going to have to reevaluate her own quality of life, without teeth…

Fenris, not entirely sure he’s kidding about that last threat.

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I hope you do.
My great grandmother is 99 and she has been happy though unhealthy the last 10 years. She has seen her great grandchildren get married and one has a child now. In the picture with all 5 generations of the family i never saw her so proud.
quality of life my ass!

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I am afraid that I would have to help the doctor in question understand some things about Quality Of Life on the spot. The first lesson would be about how his would rapidly become worse.

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About ten years ago, my Grandmother was in her 60’s when a doctor failed to follow up on a breast lump because he felt she was too old for it to matter.

Fortunately she switched doctors and the new one noticed that the lump had been noted but never biopsied. It was not malignant, but it well could have been. Doctors has also prescribed medications that are contraindicated because of our family’s history of liver disorders. Fortunately she had a second opinion who pointed it out. Her mother lived until she was 89, as did her mother IIRC. Some physicians seem to thing anything over 60 years old is just gravy. They don’t want to spend resources on someone that old.

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One of the reasons I decided to become an RN instead of a doctor was that, in general (of course there are exceptions), doctors tend to be unpleasant human beings. I have a truckload of my own stories to tell, and I’m sure many people on this board do, too.

I think it’s partly the sort of people that decide to become doctors, and partly the training process that fosters the sort of attitude that Fenris describes.

I’m sorry to hear about what you and your family are going through, Fenris. When you talk to your grandmother, make sure you let her know how much you and your family value her, even if some snotty doctor does not.

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I like to think of myself as a bit more than a glorified auto mechanic. I like the “whole patient” approach, myself, but some (like you) feel that the doctor should stay away from certain aspects of your life. I totally respect that. However, you can err on the other side, too, by seeing “the disease and not the patient”. It’s a thin line to tread.

When making decisions about treatment, you do have to take into account much more than “prolonging life”. Would you rather have six good months, or three really awful years? Would you rather have six good months, or a 50% chance at five good years? Would you rather have one really crappy month, or six really crappy months? “Quality of life” is as important as prolonging life, in my opinion, but it should be the patient’s call as to whether or not it is worth it.

All that said, that doctor had no right whatsoever to undermine the treatment decisions of your grandmother’s cardiologist–at least not in your grandmother’s presence, outside that of the cardiologist.

Lee–what you describe is malpractice. No question.

Lucretia–you’ll be surprised to find me agreeing with you, although I try to be one of those exceptions. :slight_smile:

Dr. J

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For me, when I go into a doctor, it’s either for a check-up or for a specific problem. I don’t want to discuss whether I practice safe-sex, if I come in with a sprained ankle. I want my doctor to fix what’s busted, let me know about early warning signs during checkups and leave me alone otherwise. I understand that others feel differently, and I accept that.

Actually, though intended as an insult, the ‘auto mechanic’ analogy pretty accurately describes what I want in a doctor: Fixes the problem I came in with, gives accurate information and mantainance tips during tune ups, doesn’t discuss non-relevant issues about my personal life to “treat the whole car” and I want to see any part they take out. :wink:

What you’re doing is offering information and treatment choices. This is essentially the way the cardiologist put it, and is fine. It’s informing the patient and letting her make the decision. No problem with that at all.
But the specific phrase “quality of life” has become a red light with me, since every time someone says it around my grandma, they mean “it’s risky and you’re old, so it’s not worth doing.” As far as I’m concerned, if she wants to extend her life, regardless of someone else’s opinion of the ‘quality’ that is her business and her business alone.

As with the aforementioned auto-mechanic, I don’t mind being informed that it may not be cost-effective to have a new carborator put into my decrepit car, but if I thank them for the information but still want them to do it, I don’t want any backtalk or debate.

Fenris

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This OP made steam come out of my ears! My great-grandmother is 95 and doing just fine. She doesn’t walk well but has all her wits and her hearing and sight. The idea that someone’s life has little value because there is less of it left is absolutely infuriating. If you’re lucky enough to grow old it means that there are amazing things/memories/people that you have created and your insight into human nature is probably far better than the prick of a doctor who is telling you not to bother looking forward to tomorrow. I hope that when these doctors are elderly they will remember the times that they treated their elders with disrespect and carelessness, and regret them.

DoctorJ, I hear what you are saying about the “whole patient” approach and agree that it is a more compassionate way to treat patients. My physician helped me quit smoking after 10 years (almost 2 years ago!), although I had never even considered it before I started going to him for an unrelated illness (flu). When my grandfather was diagnosed with lung cancer recently the doctor told him not to bother quitting since he only has a couple of months. In both cases the doctor looked beyond the immediate problem and considered the “quality of life” factor. My grandfather is taking chemo to add 2 or 3 months to his life - adding the discomfort of quitting cigs after 60 years just doesn’t make sense since it won’t add to his longevity.

I appreciate my doctor’s interest in my health as a whole and listen to his advice. As I grow older I want a physician I can trust to value me and treat me with respect, not tell me at a certain age that I shouldn’t bother with hope.

Fenris, kick ass.

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DoctorJ: I, too, see your point about treating the whole patient and agree on certain levels. Its important to balance treating the whole person and butting in where opinions are just that “opinions”. I also think you were more even handed in the way you put the options out there. Besides, you are describing being on the beginning end of the diagnosis and treatment. An important note is that Fenris said the doctor made this comment AFTER the decision (including all the options and the quality versus quantity of life issues) had been reviewed, evaluated and made. For some other doctor to mention this to her at that point is nothing but causing her doubt and giving her reason to second-guess her own physician/surgeon in whom she will need complete confidence.

Furthermore, I firmly believe that a good frame of mind and will to fight/survive (and just basic hope) are essential to anyone facing, undergoing and recovering from such a serious surgery.

One small example of crossing that line…an online friend in Childfree by Choice was having her tubal ligation done at a fairly early age–knowing 100% she never wanted to have children. She was prepped for surgery and everything and the doctor (not her normal OB/GYN, but a surgeon) came in to check on her chart. He looked at her chart (and I guess her dob) and said to her, “Well, I think you’re making a big mistake [at your age]–you’re going to regret this,” and walked out.

Now, after her surgery, she wrote a letter to the doctor and copied the administration saying she found his comment (especially pre-op) extremely inappropriate and, I believe, indicated he should apologize for it. The doctor wrote her back that he was “counseling her on her options” and that he stood by what he said (she posted the entire letter to the newsgroup), saying something like “if it shook her confidence, maybe she WASN’T making the right choice, etc.” and that that was his point in saying it (plus some other pious crap). To me–that’s not treating the whole patient, that’s undermining one’s confidence intentionally and unnecessarily.

My two-cents!
Peta, who has her own issues with doctors

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So Fenris - did you knock their blocks off? Are they drawn and quartered?

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This is one of the reasons that I don’t favor euthenasia. If your pissed now about doctors telling elderly patients that surgery to prolong life isn’t worth it, imagine if these same doctors took it a step further and be able to without your permission. These same doctors would have no second thoughts to persuade and goad the elderly patient, while alone, into giving up on life. And since the patient is of sound mind and body, there is nothing you can do about it since you have no proof of such duress. The witness would be dead.

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your–>you are

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My mom beat me to it. :frowning:

By the time I got there, my mom and aunt were in full rant mode, and so was my Grandma’s regular cardiologist (back in town), as well as his fill-in cardiologist. The twerp-ette doctor didn’t know what hit her. She looked like she was going to cry.

As an aside, she had her pacemaker put in yesterday afternoon and is doing fine so far. (Did you know that pacemakers are put in while the patient’s awake!? Local anesthetic only. Yuck. I’d rather be unconcious, thanks.)

Fenris

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eeewwww!

My motto for any surgery - PUT ME OUT! Put me out for anything, no matter how small. It gives me an excuse to stay in bed all day. But I digress…

GO GRANDMA!!! I am very happy to hear that she is recuperating well in mind and body. And as for that “doctor,” a story in which a weasel gets what it deserves is always the best kind of story there is.
:slight_smile: