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Less Is More
July 2016

I Wish Someone Had Told Us the Risks and Benefits of Replacing My Father’s Defibrillator

Author Affiliations
  • 1Pamela Diaconis Mktg, Philadelphia, Pennsylvania
JAMA Intern Med. 2016;176(7):885. doi:10.1001/jamainternmed.2016.1926

My father, an aeronautical engineer and one of the designers of the reentry heat shields for the Apollo spacecraft, was extremely methodical. Even when doing projects around the house, he would measure and remeasure before making a final cut.

This logic also led to his being quite candid about other issues, so even before my parents became elderly and ill, we were a family who was not afraid to talk about death. Dad always told us that he wanted to die in his sleep.

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    2 Comments for this article
    It's good to talk
    Dr Michael Bone | South Tyneside NHS Foundation Trust
    I couldn't agree more! Whilst still doing acute medical on-calls after 34 years as a General and Respiratory Physician I frequently get asked about ventilation strategies in older(>90) patients being admitted with respiratory distress by my junior colleagues? My standard response is \"have you asked the patient their feelings and thoughts about it\". It constantly surprises me that they haven't even considered that conversation.
    A 95 year old women with whom my wife is involved was recently admitted to a neighbouring hospital in atrial fibrillation and the standard discharge therapy included warfarin with frequent visits and blood tests. Having suffered from
    polio as a child she had mobility problems but was still as bright as a button. On reviewing the pros and cons, she elected to discontinue the warfarin and refused to consider NOACs.
    Last week she telephoned to express her gratitude as she'd sustained a fall, from which she made a good recovery despite superficial skin damage. She had been fearful that without our advice she would have been railroaded into an unwise therapeutic decision.
    CONFLICT OF INTEREST: General Physician currently supporting Cardiology services at my Hospital Trust.
    Questions are not asked, sometimes not answered
    Ramakant Sharma | Dignity health
    Most of the elective procedures and treatments carried out today, may fall in the category in this example.
    Problem is multifaceted.
    Patients do not ask questions, most important of which is- Is the disease curable ? If not, what benefit would I get if the above treatment is done ? What if the above treatment is not done.
    Physicians do not disclose the implications- especially the miserable quality of life after such procedures.
    There are no paragraphs in most medical books about natural history of disease.
    Probably, if patients know the natural history, like many physicians do, they will opt for comfort