Years ago,Charlie,a highly respected orthopedist and a mentor of mine,found a lump in his stomach.He had a surgeon explore the area,and the diagnosis was pancreatic cancer.
He went home the next day,closed his practice,and never set foot in a hospital again.He focused on spending time with family and feeling as good as possible.Several months later,he died at home.He got no chemotherapy,radiation,or surgical treatment.Medicare didn’tspend much on him.
It’s not a frequent topic of discussion,but doctors die,t00.And they don’t die like the rest of us.What’s unusual about them is not how much treatment they get compared to most Americans,but how little.Of course,doctors don’t want to die;they want to live.But they know enough about modern medicine to know its limits.Almost all medical professionals have seen what we call“futile care”being performed on people.That’s when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life.The patient will get cut open,perforated with tubes,hooked up to machines,and assaulted with drugs.I cannot count the number of times fellow physicians have told me,in words that vary only slightly.“Promise me if you find me like this that you’ll kill me.”
How has it come to this—that doctors administer so much care that they wouldn’t want for themselves?The simple,or not—s0—simple,answer is this:patients,doctors,and the system.
To see how patients play a role,imagine a scenario in which someone has lost consciousness and been admitted to an emergency room,and shocked and scared family members find themselves caught up in a maze of choices.When doctors ask if they want“everything”done.they answer yes.Then the nightmare begins.Feeding into the problemare unrealistic expectations of what doctors can accomplish.For example,many people think of CPR as a reliable lifesaver when,in fact,the results are usually poor.
But of course it’s not just patients making these things happen.Doctors play an enabling role,too.The trouble is that even doctors who hate to administer futile care must find a way to address the wishes of patients and families.Imagine,once again,the emergency room with those grieving family members.They do not know the doctor.Establishing trust and confidence under such circumstances is a very delicate thing.People are prepared to think the doctor is acting out of base motives,trying to save time,or money,or effort,especially if the doctor is advising against further treatment.
It's easy to find fault with both doctors and patients in such stories,but in many ways all the parties are simply victims of a larger system that encourages excessive treatment.In some unfortunate cases,doctors use the fee.for-service model to do everything they can,no matter how pointless.to make money.More commonly,though,doctors are fearful of litigation and do whatever they’re asked to avoid geeing in trouble.
The real problem the author is concerned about in this article is________.
A.the overtreatment for dying patients
B.the different attitude of doctor and patients toward death
C.the disproportionately high medicare expenditure in America
D.the unequal and non.transparent doctor—patient relationship
A.But scientists are still working to improve on that,and among them is social psychologist Aldert Vrij of the University of Portsmouth in England.Vrij has been using akey insight from his field to improve interrogation methods.In short,the truth
B.When Vrij and his colleagues asked volunteers what their offices looked like.after instructing half to tell the truth about their occupations and half to lie,both truth tellersand liars gave the same amount of detail in their verbal responses.But whe
C.All these tricks may seem like overkill when we think about the fictional detectives weknow,including Holmes Sherlock,who seem able to ferret out every falsehood theyhear without using any strategies other than their intuition.But in real life,such p
D.And in fact,that is just what happens in the lab:Vrij ran an experiment in which half the liars and truth tellers were instructed to recall their stories in reverse order.When observers later looked at videotapes of the complete interviews,they corr
E.Psychological scientists are fascinated by keen lie spotter.Detecting lies and liars isessential to effective policing and prosecution of criminals,but it is maddeninglydifficult.Most of us can correctly spot barely more than half of all lies and tr
F.Another strategy that could be surprisingly effective is to ask suspects to draw a picture. Putting pencil to paper forces people to give spatial information-something that most liars have not prepared for as part of planning t
G.Here are a few strategies that Vrij and his colleagues have been testing in the laboratory. One intriguing strategy is to demand that suspects tell their stories in reverse.Narrating backward increases cognitive load because it