Too little, too late

Last year, I saw Mr S, a wonderful gentleman in his seventies who was wheelchair bound and required constant supervision. The reason I was seeing him wasn't his paraplegia, but his terrible cholesterol and triglycerides, despite medications. I met with him and his caretaker, and we talked about his diet. In a shining moment of shared decision making and patient centered care, I asked him to tell me about what he eats and where we thought we could make changes. He proceeded to tell me about his diet, but we never got past breakfast. Every morning, he ate sausage, bacon, and 2 donuts.

We discussed what changes he could live with (his caretaker was more than willing to make the changes since her own doctor was fairly critical of her own lab results), and he agreed that he was willing to change his breakfast. He would get rid of the pork products, the donuts, and would change to a hearty bowl of oatmeal and fresh fruit. And his cholesterol and triglycerides improved dramatically. I couldn't wait to see him back in the office for his follow up appointment at 3 months, but the day before the appointment, his family called. He had died.

I can't help but feel that I made this guy's life miserable. He only had a few months left on this earth, and instead of bacon and donuts, he died with a belly full of oatmeal and cantaloupe. If I had known that we were dealing with a few months, what was the point of getting his cholesterol better? In medicine, it's really hard to know when you've been successful. Everyone dies. So what does it mean when one of my patients die? Did they meet their projected life expectancy? Did they get to median survival? The goal posts aren't the same for everyone. Maybe Mrs J who has bad COPD and CAD will be lucky to make it to 75. Maybe Mr O will live to be 100, despite his terrible diabetes.

People tell me that they appreciate the care I deliver, but it is exceptionally hard to know if you are a good doctor. Because the most important metric, are my patients living longer/better, has no control group for comparison.

After Mr S died, I went out to breakfast that weekend, and had pancakes and bacon and sausage. And I poured out some bacon and syrup for him.

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