New approach needed to ‘diagnose dying’


By Amanda Sheppeard

6 Jun 2016

More education is needed to help doctors ‘diagnose dying’ and avoid becoming caught up in providing futile treatment to patients, say researchers.

And they have found that, contrary to popular belief, a lot of futile treatment is driven by doctors themselves, not only patients and their families.

In a new paper led by researchers at the Queensland University of Technology’s Australian Centre for Health Law Research, and published in the British Medical Journal’s Journal of Medical Ethics, the researchers reveal the results of a series of semi-structured, in-depth interviews carried out at three large tertiary public hospitals in Brisbane.

The 96 doctors who took part came from a range of specialties and departments, including emergency, intensive care, palliative care, oncology, renal medicine, internal medicine, respiratory medicine, surgery, cardiology, geriatric medicine and medical administration.

Lead author, Professor Lindy Willmott, told the limbic this was the first wide scale empirical research of its kind in Australia, and while many of the results were no surprise, it was interesting to see that doctors’ “inherent desire to go down a curative pathway is a driver for futile treatment.”

“We all know futile treatment is not good for patients, families or doctors,” she said.

“Doctors go into the medical profession because they want to save people and cure people. A lot of doctors see death as a failure.”

Professor Willmott said the research was particularly important because it reflected the voices of the doctors themselves. The paper provides a snippet of direct comments from the doctors and it provides an interesting insight many clinicians will relate to.

“… they’re trained to treat. You don’t learn—you learn how to treat and it’s easy to treat. It’s much easier to treat than to have those high level discussions where you talk about end of life and not treating. So the default is to keep treating,” said one geriatric medicine consultant.

“…you do a procedure because it can be done, even if it doesn’t change the outcome. … recently … we did a big operation to take out most of his cancer. But because it was only most of it, it’s not actually going to change anything. If we’d thought that through beforehand, we would’ve not done that treatment,” said a surgery consultant.

Professor Willmott said there appeared to be a need to separate dying from illness, as it needed a different approach from doctors.

“A good starting point would be educating doctors and giving them the skills to be able to diagnose dying – essentially switching from a curative track to a palliative track,” she told the limbic.

“There also needs to be more training on how to communicate this to the patient and family. The treatment for dying patients needs to be different and that could be in the long run better for everyone concerned.”

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