Decision-making in medicine.

Thanks. Found that interesting. Reminds me of the conversation with my consultant about a possible TKR. He’s the only person that has pointed out that there is a one in five chance that I might regret the operation and to look at what my life is like without having it done. Because of that I have more faith in him than someone who just encourages me to have it done.

I had a good conversation with a consultant some years ago too - but I'm a "facts" and "percentages" person so that is generally easier.

One in 5 is quite high it seems to me!
I'd want to see the studies but what did you decide?

I thought the "tools" or talking points lower down in the article might be useful to others.

“Conclusion: Based on our review, the average rate of patient dissatisfaction following TKA is 10%. Improved counseling for known risk factors may have reduced dissatisfaction rates by increasing preoperative patient optimization. Many studies in recent years have demonstrated the issue of poor patient coping skills, such as pain catastrophizing and anxiety/depression as a common cause of dissatisfaction. Ultimately, dissatisfaction following TKA still continues to affect a high portion of patients but less than historical reports of 20%”.
I think his comment was probably down to the fact that most people have a TKRbecause they’re in constant pain and I’m not, at least not when I’m not walking.

I had many conversations with my mum’s consultant.

His final conversation with me was if it was my mother, I would stop treatment and call the hospice

I followed his advice.

A consultant paediatrician I worked with, highly regarded and respected, said to me one time “Just because we have the expertise and knowledge to do something doesn’t mean we always should.”

Following angioplasty recently, I got to see my actual nominated GP whom I've known for about 25 years. I asked him if he thought that doctors over-treat the elderly. "Probably," he said.

I would disagree most strongly about over-treating elders.

I hear stories of pushing palliative care, and even DNR onto people over 65.

But outsourcing of scanning and diagnostics means that these are done routinely with little follow up.

I agree the elderly sometimes seem to be kept alive long past their sell by date. I'm not being brutal, I absolutely apply that to myself. You sometimes see on TV wizened old people lying in beds who look like corpses, probably being fed a cocktail of drugs. Do they want to keep going or is it that their family won't let them go?

My mother-in-law was offered heart surgery at 99. She declined after two consultations.
She asked for a DNR but did want treating for (say) an infection which it was thought could be cleared up.
She said the thing she was most anxious about was to be in pain.

I don't think there is a "standard" over or undertreatment... at least not in our experience - but I do think it's important to have time and have someone knowledgeable and thoughtful and empathetic to talk things through with.
She had one GP who was useless and a couple who asked the "right" questions and really listened to her answers.

Being just 10lbs overweight puts 50/60 lbs of pressure on your knees with each step. Before you even consider surgery get the weight off. I would have the TKR only if when down to size I was in constant pain. Surgery is a last resort. I do think we are getting like USA and prolonging life when there will be no quality. Treat infections etc. I was told I need hip replacing, However like Maybee not in constant pain, I have lost a lot of weight and nearly there, reduced the walking I was doing and do exercises, not perfect but adapted. I can't be as I was thirty years ago. A neighbour had her hip done but she was at least 4 stone overweight, she wouldn't exercise, said it was was painful, now uses a wheelchair.

Oh I definitly believe we over treat the very elderly and can give many examples but I ll stick to one, my best friend who is 90 this month is a very sane, sensible clear thinking woman with no after life beliefs She had had a number of procedures though her eighties, new knee, new hip, some blood transfusions etc etc but had talked to me many times about not wanting to be ‘saved’ any more. She proudly told me many times she had her DNA letter which went everywhere with her she lodged her wishes with her doctor, and hospital consultant. She was so thrilled it was all completed, (her family live a good way away)
However when she was found unconscious and rushed into hospital (with her letter) , her life was saved when I went to see her afterwards she had a catheter in and a feeding tube up her nose, she could not talk only gobbledegook she’d had a major stroke. fast forward a few months she still can only talk babble but her mind is functioning, she is locked in …Her family have sold her precious home to keep her in the care home, she is very unhappy and cries with whispered unintelligible words when I visit.
The last time I went she had been taken to hospital to have the first appointment for a cateract operation as her name was next on the list !!!!!!!
I so agree with that doctor that said just because we can doesn’t mean we should
My DNA letter will be very specific

BlueBelle

That is just so wrong, re your friend.

Not in her best interests, her family’s, or the general public awaiting procedures.

There is a complete difference in pushing palliative care and even DNR onto people over 65 and keeping very old, frail folk alive who have little quality of life and no desire to still be living.

There was a woman in her 80s who had DNR tattooed on her chest.

I think that is the only solution. If you (say) collapse in the street and don't want resuscitation... and even then it might not work.

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I always think that the first decision should be 'do nothing'. What would happen if we decided not to take any action , what might the outcome be? For me that's where I would start and that is how I was trained to think in clinical situations.