A 72 year old man in terminal heart failure with three previous admissions in last one year comes with severe breathlessness . He was exhausted with rigorous drug regimens for refractory heart failure in the past few months. Since he was always feeling better after an infusion of Dobutamine he demanded it . Doctors were very clear , ” Repeated Dobutamine infusion will hasten the LV dysfunction and longevity is will shorten”
The family began to think . While they wished for him to live longer , the sick man insisted on early relief from his symptoms .
How often in medicine , there is a trade off between symptoms and survival ?
It is a more common situation than we believe , especially in many chronic disorders like terminal organ failure and malignancies. . So we need a simple scale to asses the quality of life and survival outcome for our patient. The following table could help us . I learnt this from the great teacher Valentine Fuster’s lecture which I attended in New Delhi recently !
Let us attempt to make a patient’s life ” feel good “ , if he is going to live shorter . Let us avoid prolonging a life , if the treatment is making him feel bad , when the life expected is short !