Why do some doctors wear... Why do doctors wear white coats? Last will - not to treat: doctors leave quietly
Original taken from pauluskp Why do doctors ask themselves not to pump and die at home, not in the hospital?
On the topic of doctors who kill for a long time, expensively and painfully, according to all the rules of medical science. An oldie but a goodie from The Wall Street Journal.
A medical doctor from Southern California explained why many doctors wear pendants with the inscription “Do not pump” so that they do not have chest compressions in the event of clinical death. And also why they prefer to die from cancer at home.
Many years ago, Charlie, a respected orthopedic surgeon and mentor of mine, discovered a lump in his stomach. He underwent exploratory surgery. Diagnosis: pancreatic cancer. The operation was performed by one of the best surgeons in the country. He even developed an operation that tripled the likelihood of surviving five years after diagnosis of this particular type of cancer from 5 to 15%, although the quality of life would be very poor. Charlie was completely uninterested in the operation. He left the hospital the next day, closed his practice and never set foot in a hospital again. Instead, he devoted all his remaining time to his family. His health was as good as it could be when diagnosed with cancer. A few months later he died at home. Charlie had no chemotherapy, radiation or surgery. The state insurance for retirees, Medicare, spent almost nothing on his maintenance and treatment.
This topic is rarely discussed, but doctors die too. And they die differently than other people. What's striking isn't how much medical treatment doctors do before they die compared with other Americans, but how rarely they see a doctor when it's nearing the end. Doctors struggle with death when it comes to their patients, while they themselves have a very calm attitude towards their own death. They know exactly what will happen. They know what options they have. They can afford any type of treatment. But they leave quietly.
Naturally, doctors do not want to die. They want to live. At the same time, they know enough about modern medicine to understand the limits of science. They also know enough about death to understand what all people fear most - dying in agony and dying alone. They talk about it with their families. Doctors want to make sure that when their time comes, no one will heroically save them from death by breaking ribs in an attempt to revive them with chest compressions (which is exactly what happens when it's done correctly).
Almost all health care workers have at least once witnessed a “futile treatment,” when there was no likelihood that a terminally ill patient would benefit from treatment with the latest advances in medicine. The patient's stomach will be ripped open, tubes will be stuck into it, connected to machines and poisoned with drugs. This is exactly what happens in intensive care and costs tens of thousands of dollars per day. With this money, people buy suffering that we will not inflict even on terrorists. I have lost count of the number of times my colleagues have told me something like this: “Promise me that if you see me in this state, you will kill me.” They say this in all seriousness. Some doctors wear pendants with the inscription “Do not pump” so that doctors do not give them chest compressions. I even saw one person who got such a tattoo.
Treating people while causing them suffering is painful. Doctors are trained to collect information without showing their feelings, but among themselves they say what they experience. “How can people torture their loved ones like this?” is a question that haunts many doctors. I suspect that the forced suffering of patients at the request of their families is one of the reasons for the high rates of alcoholism and depression among health care workers compared to other professions. For me personally, this was one of the reasons why I have not been practicing in a hospital setting for the last ten years.
What's happened? Why do doctors prescribe treatments that they would never prescribe for themselves? The answer, simple or not, is patients, doctors and the medical system as a whole.
To better understand the role patients themselves play, imagine the following situation. The man lost consciousness and was taken by ambulance to the hospital. No one foresaw such a scenario, so it was not agreed in advance what to do in this case. This is a very common situation. Families are frightened, overwhelmed, and confused by the myriad of treatment options available. My head is spinning. When doctors ask, “Do you want us to “do everything”?”, the family says “yes.” And all hell breaks loose. Sometimes a family really wants to “get everything done!”, but more often than not they just want everything done within reason. The problem is that ordinary people often do not know what is reasonable and what is not. Confused and grieving, they may not ask or hear what the doctor says. And doctors who have been told to “do everything” will do everything, whether it is reasonable or not.
Such situations happen all the time. To make matters worse, people have unrealistic expectations of what doctors can do. Many people think that artificial heart massage is a reliable method of resuscitation, although most people still die or survive with deep disabilities. I have received hundreds of patients who were brought to my hospital after resuscitation with artificial heart massage. Only one of them, a healthy man with a healthy heart, left the hospital on his own feet. If the patient is seriously ill, old, or has a terminal illness, the likelihood of a good outcome from resuscitation is almost non-existent, while the likelihood of suffering is almost 100%. Lack of knowledge and unrealistic expectations lead to poor treatment decisions.
Of course, not only patients are to blame for the current situation. Doctors make useless treatments possible. The problem is that even doctors who abhor futile treatment are forced to satisfy the wishes of patients and their families. Imagine again a trauma center in a hospital. Relatives are crying and hysterical. They see the doctor for the first time. To them he is a complete stranger. In such conditions, it is extremely difficult to establish a trusting relationship between the doctor and the patient’s family. People tend to suspect the doctor of not wanting to bother with a difficult case, saving money or their time, especially if the doctor does not advise continuing resuscitation.
Not all doctors know how to talk to patients in accessible and understandable language. Some people get it better, some get it worse. Some doctors are more categorical. But all doctors face similar problems. When I needed to explain to a patient's relatives about various treatment options before death, I told them as early as possible only about those options that were reasonable under the circumstances. If relatives offered unrealistic options, I conveyed to them in simple language all the negative consequences of such treatment. If the family still insisted on treatment, which I considered pointless and harmful, I suggested transferring them to another doctor or hospital.
Should I have been more persistent in convincing relatives not to treat terminally ill patients? Some of the times I refused to treat a patient and referred them to other doctors still haunt me to this day. One of my favorite patients was a lawyer from a famous political clan. She had severe diabetes and terrible circulation. A painful wound appeared on her leg. I tried to do everything to avoid hospitalization and surgery, realizing how dangerous hospitals and surgery are for such a patient. She still went to another doctor, whom I did not know. That doctor hardly knew the woman’s medical history, so he decided to operate on her - to bypass the thrombotic vessels in both legs. The operation did not help restore blood flow, and postoperative wounds did not heal. Gangrene developed on her feet, and both legs were amputated. Two weeks later she died at the famous hospital where she was treated.
It would be too much to point the finger at patients and doctors when often both doctors and patients are victims of a system that encourages overtreatment. In some sad cases, doctors are simply paid for every procedure they do, so they do whatever they can, whether it helps or hurts the patient, just to make more money. Much more often, however, doctors are afraid that the patient’s family will judge them, so they do everything that the family asks, without expressing their opinion to the patient’s family, so that there are no problems.
Even if a person has prepared in advance and signed the necessary papers, where he expressed his preferences about treatment before death, the system can still devour the patient. One of my patients' name was Jack. Jack was 78 years old, had been ill for many years and had undergone 15 major surgeries. After all the troubles, Jack quite confidently warned me that he never, under any circumstances, wanted to end up on artificial respiration. And then, one Saturday, Jack had a stroke. He was taken to the hospital in an unconscious state. Jack's wife was not with him. The doctors did everything possible to pump him out and transferred him to intensive care, where he was connected to an artificial respiration apparatus. Jack feared this more than anything in his life! When I got to the hospital, I discussed Jack's wishes with the staff and his wife. Based on my documents, compiled with Jack's participation, I was able to disconnect him from life-sustaining equipment. Then I just sat down and sat with him. Two hours later he died.
Despite the fact that Jack drew up all the necessary documents, he still did not die the way he wanted. The system intervened. Moreover, as I found out later, one of the nurses slandered me for disconnecting Jack from the machines, which means I committed murder. Because Jack wrote down all his wishes in advance, I didn’t have anything. But still, the threat of a police investigation strikes fear into any doctor. It would have been easier for me to leave Jack in the hospital on the equipment, which was clearly against his wishes, prolonging his life and suffering for several more weeks. I would even make more money, and Medicare would receive a bill for an additional $500,000. It's no wonder that doctors tend to overtreat.
But doctors still don’t re-treat themselves. They see the consequences of overtreatment every day. Almost everyone can find a way to die peacefully at home. We have many options for pain relief. Hospice care helps terminally ill loved ones spend their final days in comfort and dignity, rather than suffering from unnecessary treatment. It is amazing that people cared for by hospice live longer than people with the same illnesses who are treated in hospital. I was pleasantly surprised to hear on the radio that the famous journalist Tom Wicker “died peacefully at home, surrounded by his family.” Such cases, thank God, are becoming more common.
A few years ago, my older cousin Torch (torch - lantern, burner; Torch was born at home by the light of a burner) had a seizure. As it turned out later, he had lung cancer with metastases to the brain. I made arrangements with various doctors and we learned that if his condition was treated aggressively, which meant three to five hospital visits for chemotherapy, he would live about four months. Torch decided not to undergo treatment, moved to live with me and only took pills for brain swelling.
For the next eight months we lived happily, just like in childhood. For the first time in my life I went to Disneyland. We sat at home, watched sports programs and ate what I cooked. Torch even gained weight on home-cooked food rather than hospital food. He was not tormented by pain, and his mood was fighting. One day he didn't wake up. For three days he slept as if in a coma, and then he died. The cost of medical care for eight months is about $20. The cost of the pills he took.
Torch was not a doctor, but he knew that he wanted to live, not exist. Don't we all want the same thing? If there is a super-duper end-of-life care, it is death with dignity. As for me personally, my doctor is informed of my wishes. No heroism. I'll quietly go into the night. Like my mentor Charlie. Like my cousin Torch. Like my fellow doctors.
This question has been “circling” around me for a long time. Have you noticed that, for example, doctors at receptions, nurses and other medical workers often wear white coats and clothes, but in the operating room you will never meet a person in white. Why is this so?
At first they convinced me that this was because if blood got on white, it would look “scary and shocking”, they say it would destabilize the patients - the surgeon was dressed in white and covered in blood.
I believed in this and “threw” this question away. But it turns out that I was misled. It’s not at all a matter of fear and horror of blood on white!
And the whole point is this...
Have you ever wondered why doctors in the operating room wear green or blue uniforms, but not white? It turned out that the success of the operation could depend on such a small detail.
Initially, all medical clothing was white, until in 1914 one influential doctor abandoned this uniform in favor of green, and then blue. The fact is that the crystal white color can blind the surgeon for a few moments if he turns his gaze from the dark color of the blood to the gowns of his colleagues. We experience the same thing when we go out of the house and look at the snow on a sunny day.
But why are the uniforms of doctors in the operating room blue and green, and not purple or yellow? The fact is that green and blue in the color spectrum are opposite to red, and during surgery surgeons continuously look at red blood.
The retina of our eyes consists of rods, which allow us to see in dim light, and cones, which function in normal light. Humans have three types of cones with varying levels of sensitivity to red, green and blue. Red-sensitive cones are the most numerous. This explains why red captures our attention faster than other colors.
Thus, the shape of green and blue colors not only stimulates the vigilance of doctors' eyes, but also makes them more receptive to shades of red. And therefore, to the nuances of human anatomy, which significantly reduces the likelihood of errors during surgery.
sources
Why do many doctors wear tattoos with the message “Do not resuscitate”, “Do not pump out” - maybe they don't believe in the power of modern medicine? This is not entirely true. Doctors save lives; they see death and suffering. An emergency doctor is obliged to provide assistance to any person - be it a millionaire or a beggar. Why does he refuse to have anyone help him?
Pendants and tattoos with the inscription “Do not pump out”: why do doctors choose death?
Every doctor (especially if he is a surgical oncologist or traumatologist) encounters deaths in his practice. A doctor is an ordinary person who goes to work every day. His job description is simple: to save lives and protect human health. Every doctor realizes that he or she may someday find himself in the place of his patient. And an ordinary person, a doctor like himself, will save him. Not omnipotent, not omniscient, not omnipotent. who, like him, knows what awaits a person after a seizure, stroke or as a result of an accident. For example, when the heart stopped or when clinical death occurred.
Did you know that the chances of survival in this case are very small? And even if a person survives, he will not be able to return to normal life and leave the hospital on his own two feet? Also, during chest compressions, the patient’s ribs can be broken in order to save his life. Doctors know all this very well and want to protect themselves and their loved ones from a similar fate. They have seen so much suffering, pain and torment that they do not want this for themselves. They are well versed in the trends and capabilities of modern medicine, they know how much it will cost and what their short-term resuscitation will cost their relatives. That's why doctors wear pendants and tattoos with the inscription: "Do not pump." They do not want to be returned to a life that will then be inferior.
“Do not resuscitate”: medical secret revealed
Still, some people still don’t understand why many doctors wear tattoos with the message “do not resuscitate.” After all, a doctor provides help to other people without asking whether they want it or not. Doctors are doing everything possible to save lives. For some it is a job, for others it is a calling. Some doctors want to receive substantial monetary compensation from the patient’s relatives and friends. However, doctors stubbornly refuse to use all possible and impossible methods to survive. Doctors prefer to leave calmly and with dignity than to remain disabled. Doctors don't want to suffer. They are not cynics or cowards. They love their loved ones very much and understand the trials a person whose relative has lost the ability to move must go through.
Even if a doctor takes measures to save a person, he does not know what the final outcome will be. But he knows how much suffering, money and physical effort will be required on the part of relatives, staff and the patient himself. That's why doctors wear pendants with a message warning them not to resuscitate them. People without medical practice may consider this decision blasphemous and selfish. However ordinary people overly idealize the possibilities of medicine. After all, a person may be terminally ill or too old to fight for life, and desperate attempts to bring him to his senses will bring him hellish pain and unbearable sensations in his last minutes. The doctors know all this, and therefore ask not to resuscitate them. And not because they consider themselves the only luminaries and do not trust anyone.
Last will - not to treat: doctors leave quietly
Why do doctors refuse resuscitation when dying? One distinguished doctor from the USA told the story of his mentor, a doctor who was diagnosed with pancreatic cancer. The man had the opportunity to use the services of one of the best surgeons in the country, but he refused. He left his job, left the hospital and never appeared there again. The former orthopedic surgeon dedicated the remaining few months of his life to his family. Why did he refuse surgery, chemotherapy and qualified treatment? The fact is that the man knew that his chances of surviving at least 5 years after the operation were 15%. However, at the same time he will be a burden to his relatives and loved ones. He didn’t want this either for himself or for his family. Doctors want to leave with dignity, without losing their composure and common sense. They are confident that care and attention, as well as the patient’s ability to respond normally to the presence of loved ones, are the best things that can happen to a person in his last days. This is precisely their medical truth.
Hello, dear friends! Every third Sunday in June, the entire medical community celebrates its professional holiday. And today my article is dedicated specifically to health workers. Or rather, I want to tell you why doctors wear white coats. Did you know that they appeared among doctors relatively recently as an attribute of special clothing?
Seeing a white coat on a person, we immediately understand that this is a medical worker. And the association immediately arises that we are in the reliable hands of professionals and that no matter what happens to us, they will definitely help us.
Each profession has its own uniform: military, police, sailors, postal workers, railway workers. Now it is difficult to imagine hospital and clinic staff without white coats. True, there are variations with color and models, but it is the white robe that already on a subconscious level inspires confidence in us. But it wasn't always like this.
The word “robe” is not Russian, it is borrowed from the Arabic language - hil at and is translated as “dress of honor.”
People first started talking about white coats in the second half of the nineteenth century. Until this time, doctors, when providing medical care, wore ordinary aprons. If necessary, they also wore gloves. Previously, doctors were recognized not by their clothes, but by their deeds, and all doctors were known by sight. For the first time, the British started talking about white coats.
In the 60s of the 19th century, an English surgeon-hygienist from the English city of Glasgow, Joseph Lister, began to develop the theory of antiseptics, which was quickly recognized by the medical community. He used carbolic acid to treat wounds. At the same time, he developed the theory that white coats also have antiseptic properties. From this time the history of medical gowns begins.
Joseph Lister
There was a lot of controversy, but life put everything in its place when the Spanish Flu raged in Europe in 1918-1919, killing tens of millions of people. It was at this time that the wearing of white coats became widespread: not only surgeons, but also doctors of other specialties began to wear them.
There are other, non-traditional versions of the history of the origin of white coats. For example, an eastern legend assures us that not only the symbol of medicine - a bowl with a snake - is borrowed from the teachings of Ayurveda, but also the modern uniform of a doctor - a white coat, cap, trousers and a face mask. This is exactly what the ritual clothing of the Atharvans, the ancient Zoroastrian healers, looked like. When treating the sick or performing rituals, healers dressed in white as a symbol of purity. The bandage on the face served to prevent their breath from desecrating the sacred creation of fire.
It is believed that the Germans began to wear white coats constantly during work during the Franco-Prussian War.
Medical gown in Russia
The robe came to Russia in the 18th century and was first used as home clothing; only later, at the end of the 19th century, did it become medical. There are several versions of when the white coat became the work clothes of doctors.
This happened at the turn of the nineteenth and twentieth centuries. For the first time, doctors wore a white coat during the Russian-Turkish War in 1877-1878.
But a more reliable version is when doctors from the Burdenko Hospital in St. Petersburg first put on white coats in the 80s of the 19th century.
Why white?
In the 20th century, the professionalism of surgeons was assessed by the white coat: the quality of the operation was determined by the presence of blood on the coat.
For some time now, debates have begun in England about the appropriateness of white in special clothes. medical staff clothing. Once upon a time, English doctors decided to abandon white coats, but over time they abandoned this experiment. This was explained by the fact that patients began to distrust and be wary of doctors.
UK scientists began to study how white color affects patients. The answer was given by the science of colorimetry. Everyone knows how mood and emotions change depending on the surrounding color. And this was proven not only experimentally, but also physically. Thus, red color excites, green calms, blue inspires peace and a sense of eternity...
According to colorimetry, white color is the most energetic, stimulates activity, inspires the idea of purity, innocence, innocence, incites dedication, and has a beneficial effect and special trust on patients.
How do doctors dress now?
If previously the fabric of dressing gowns was always made only of cotton, now they began to use a mixture of natural and synthetic fibers when sewing. Thanks to such materials, doctors look modern and stylish.
Recently, more and more often, the special clothing of doctors is becoming green, pink, blue, etc. Now it has become fashionable, and perhaps even advisable, to wear special clothing in different colors. By the color of the gowns or suits you can judge in which department the doctor works. Modern technologies also force the need to move away from white: reflection from lamps in operating rooms and treatment rooms with white walls.
But no matter what color the medical gowns are, the doctor’s white coat will always be his calling card. This clothing has still not lost its popularity among doctors and nurses. This is the story of the white coat.
Dear readers, on my blog there is another article about one medical attribute - a syringe, how it appeared, what this one was and became. Read this interesting story too.
Dear colleagues! I congratulate you on our wonderful holiday! I wish you all health, success and prosperity!
Doctors and nurses
May you live very brightly!
Are you a nurse or a doctor -
May there be a lot of luck!
And to everyone who put on their dressing gowns,
And to everyone who entered the chambers,
Let life be fair
Affectionate and patient!
If you liked the story of the white coats, share the story with your friends!
Be healthy! Taisiya Filippova was with you.
Some professions have their own uniform, from the appearance of which we immediately understand that this is a policeman, a fireman, a train conductor, or a military man. When we come to the hospital and see medical workers in gowns of the color familiar to us since childhood, we immediately feel a sense of calm and confidence that you will receive qualified care.
A little history
The history of the medical gown began in the distant 19th century. Initially, in order to assist the patient and protect him from contamination, the doctor was required to wear a simple apron of any color, and sometimes gloves. This was enough, since he was recognized not by his appearance, but by his merits, as they say, “by sight.” The first thoughts and conversations about the need to use special clothing appeared in the sixties among the medical community of Foggy Albion. D. Lister developed theoretical data according to which a robe of this color has important antiseptic properties. But dressing gowns began to be used everywhere almost 60 years later, when the terrible “Spanish flu” disease hit European countries, quickly claiming the lives of millions of women, men and children. Gradually, doctors of all specialties (surgeons, therapists) began to wear them.
The history of its appearance in Russia has several versions, the most reliable is the one according to which in the eighties of the 19th century, the robe became in demand as work clothes among doctors at the Burdenko Hospital, located in the northern capital.
Features of white color
An assistant in solving and explaining this issue is the science of colorimetry. According to statistical data and experiments, white color helps build trust between two parties. It has a beneficial effect on the subconscious of not only the patient, but also the doctor himself. A specialist becomes more concentrated in his work, he develops purity of thoughts and an idea of purity, as well as such important qualities as dedication, energy and openness. And this applies not only to doctors, but also to all medical personnel of the hospital (nurses, orderlies).
IMPORTANT! It is worth noting the other side of the issue. White is a sign of sterility, which is important in the medical field. White cotton clothes withstand high temperatures when washing (up to 90 degrees), boiling, the use of chlorine-containing detergents and hot ironing. Therefore, centralized processing does not pose any difficulties.
Why a robe
The main criterion for choosing a uniform is ease of quickly putting on everyday clothes, since often time for this procedure is limited.
From the history of the 20th century: the level of professionalism of a doctor could be assessed by the degree of contamination of work clothes with blood after an operation: the cleaner it remained, the better and more efficiently the surgeon handled the patient’s treatment.
From Arabic, robe is translated as “dress of honor.” And that says a lot. The person who wears it must understand the full extent of the responsibility of his business and will be distinguished by nobility.
In modern medicine, not only gowns of various colors are used (turquoise, green, pink, blue), but also special suits. In children's departments you can find special clothing with various designs on it to attract the attention of young patients. But still, the snow-white robe remains the calling card of most departments of medical institutions.
