End-of-life medical treatment of older cardiac patients.
The last decade saw breathtaking advances in the science and technology of heart disease. Fewer patients die from an acute myocardial infarction or acute stroke, or have a sudden death. Thanks to modern technology, people live much longer, but more than half still die of heart disease, mostly chronic. Training programs concentrate on mastery of procedures; the discipline of cardiology has become fragmented into noninvasive, nuclear, invasive, interventional, electrophysiology, heart failure, transplantation, and research. Dying persons expect to receive attention to their spiritual and psychosocial, as well as their physical needs. Ordinary people speak of lack of suffering, no unnecessary interventions that postpone the moment of an inevitable dying, not being a burden on others, and having a sense of control. Their assessment of quality may not match that of doctors who speak in terms of science and technology. Review of the limits of modern technology; understanding of existing laws; the near irrelevance of living wills; the role of the physician in the diagnosis of medical futility; the early indications of depression; and, more importantly, better communication with the patient and his/her loved ones are essential components of the practice of medicine. Cardiologists should differentiate between what should be done and what could be done for their patients.
Basta
Lofty L
LL
University of South Florida, Tampa, USA.
D016223:Advance Directives / Q000706:statistics & numerical data; D002309:Cardiology; D017048:Health Care Costs / Q000706:statistics & numerical data; D006333:Heart Failure / Q000401:mortality*; D006801:Humans; D010819:Physician's Role / Q000523:psychology*; D013727:Terminal Care / Q000523:psychology*