Doctors as patients - do doctors die differently?

Doctors as patients - do doctors die differently?

A large Canadian study has investigated whether the end of life of doctors differs from the rest of the population. They also asked whether doctors are more likely to refuse intensive treatment because of their medical experience.

Similar causes of death, a little older age

The researchers analyzed deaths from 2516 physicians (89.3% men) and 954.836 others in the Canadian province of Ontario between 2004 and 2015. After adjusting for age, gender, and income, there remained 7513 subjects in the control group. At the age of 82, the doctors were slightly older than the other professions (80 years old).

The most common cause of death in both groups was ischemic heart disease (about 13%), followed by cerebrovascular disease and lung cancer. Overall, the doctors had fewer comorbidities, and they rarely lived in rural areas.

The proportion who died at home was similar in both groups (42.8% of physicians, 39% of non-physicians). However, doctors died more often in the intensive care unit (11.9% vs. 10%). In the case of deaths at other hospital wards, the proportion of physicians under the age of 45 was 12.5%, compared with 37.5% at the age of 84 years. A similar distribution was also seen among the non-doctors.

More frequently intensive treatment

In the 6 months before death, doctors were less frequently in the emergency department, but the number of hospital stays was not different compared to the other occupations. In contrast, physicians were more frequent than patients in intensive care units and received more food through a nasogastric tube. There were no differences in artificial respiration, dialysis and cardiopulmonary resuscitation.

Patients were more likely to receive palliative treatment (52.9% vs. 47.4%) and the number of home visits to care was higher (54.3% vs. 50.1%). Among the 1,375 physicians with a chronic illness, there were no differences in treatment compared with 4,117 controls. However, chronically ill doctors died more often at home.

Cancer patients and opioids

There were 457 physicians diagnosed with cancer and 1347 cancer deaths with similar characteristics. Even in these patients, doctors often died in their own homes. Chemotherapy in the last six months before death received 37.9% of doctors, but only 29.8% of the comparison group. This contradicts the assumption that doctors as patients decide against intensive therapy.

Among physicians and non-physicians over the age of 65, physicians received a prescription for at least one opioid more frequently in the last half of the year (48.4% vs. 46.6%). The duration of the opioid prescription was longer for physicians (13.8 days vs. 13.1 days). When looking at the cost of end-of-life care, there were no differences between physicians and other patients.