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Why Doctors Die Differently
Careers in medicine have taught them the limits of treatment and the need to plan for the end

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It's not something that we like to talk about, but doctors die, too. What's unusual about them is not how much treatment they get compared with most Americans, but how little. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care that they could want. But they tend to go serenely and gently.

Doctors don't want to die any more than anyone else does. But they usually have talked about the limits of modern medicine with their families. They want to make sure that, when the time comes, no heroic measures are taken. During their last moments, they know, for instance, that they don't want someone breaking their ribs by performing cardiopulmonary resuscitation (which is what happens when CPR is done right).
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In a 2003 article, Joseph J. Gallo and others looked at what physicians want when it comes to end-of-life decisions. In a survey of 765 doctors, they found that 64% had created an advanced directive—specifying what steps should and should not be taken to save their lives should they become incapacitated. That compares to only about 20% for the general public. (As one might expect, older doctors are more likely than younger doctors to have made "arrangements," as shown in a study by Paula Lester and others.)

Why such a large gap between the decisions of doctors and patients? The case of CPR is instructive. A study by Susan Diem and others of how CPR is portrayed on TV found that it was successful in 75% of the cases and that 67% of the TV patients went home. In reality, a 2010 study of more than 95,000 cases of CPR found that only 8% of patients survived for more than one month. Of these, only about 3% could lead a mostly normal life.

Unlike previous eras, when doctors simply did what they thought was best, our system is now based on what patients choose. Physicians really try to honor their patients' wishes, but when patients ask "What would you do?," we often avoid answering. We don't want to impose our views on the vulnerable.

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By Richard A. Serrano

February 28, 2012, 9:00 a.m.
Washington—
Federal law enforcement officials announced what they called the largest healthcare fraud case in the nation’s history, indicting a Dallas-area physician for allegedly bilking Medicare for nearly $375 million in billings for nonexistent home healthcare services.

Top Justice Department officials, working for several years to stem a rampant rise in healthcare fraud around the country, also revealed Tuesday that 78 home health agencies that were working with the physician, Dr. Jacques Roy, will be suspended from the Medicare program for up to 18 months.

FBI agents in Texas arrested Roy, of Rockwall, Texas, a physician for 28 years, and asked a federal judge in Dallas to keep him in custody until trial, citing his vast “bank accounts, a sailboat, vehicles and multiple pieces of property” as indications he may attempt to flee.

Facing life in prison and a $250,000 fine, as well as restitution of the vast sum of money he allegedly cost the federal government, Roy is to appear in court in Dallas later Tuesday.

Under the alleged fraud scheme, the doctor and his office manager in DeSoto, Texas, Teri Sivils, who was also charged, allegedly sent healthcare “recruiters” door-to-door asking residents to sign forms that contained the doctor’s electronic signature and stated that he had seen the residents professionally for medical services he never provided.

They also allegedly dispatched more “recruiters” to a homeless shelter in Dallas, paying $50 to every street person they coaxed from a nearby parking lot and signed him up on the bogus forms.

The long-running ruse allegedly began in 2006 and over five years collected more Medicare beneficiaries than any other medical practice in the United States.

Atty. Gen. Eric H. Holder Jr., in testimony Tuesday before a House appropriations subcommittee, said the Department of Justice is making healthcare fraud a centerpiece of its enforcement efforts. He said that in the last fiscal year alone, they had recovered nearly $4.1 billion in funds “that were stolen or taken improperly from federal healthcare programs.”

He added, “This represents the highest amount ever recovered in a single year.”

At the same time, Holder said, federal prosecutors opened 1,100 new criminal healthcare fraud investigations, won more than 700 convictions and initiated 1,000 new civil healthcare fraud investigations.

In all, he said, for every dollar spent fighting healthcare fraud, “we’ve been able to return an average of $7 to the U.S. Treasury, the Medicare Trust Fund” and other government entities.