DÄ internationalArchive15/2017Assure That Diagnosis Is Useful to Therapy Goal

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Assure That Diagnosis Is Useful to Therapy Goal

Dtsch Arztebl Int 2017; 114(15): 271; DOI: 10.3238/arztebl.2017.0271a

Thöns, M

LNSLNS

I thank the authors for an overview of the differential diagnosis of dyspnea that is responsive to curative treatment (1). That, however, was not the subject of the article's title. The symptom of shortness of breath is a predictor of increased mortality and often manifests itself in people with multimorbidity near the end of life. For instance, cardiac causes of dyspnea is a worse prognostic factor of long-term survival than colorectal cancer (2).

Even with symptoms such as deep unconsciousness or inspiratory crackles, the obvious differential diagnosis of “dying person” is not mentioned in the article. Yet in these cases, it is a matter of the code of medical ethics to refrain from burdensome examinations. For lung infections, it is often claimed that elderly people should always receive stationary treatment—yet this is often against their will and is even contraindicated for dying persons.

Nevertheless, the article explains the various invasive diagnostic possibilities, although only the markers FEV1, NT-proBNP, and the emphysematous change are predictors. Coronary angiography, for example, is not an indication for this case, even though Germany is a world leader in it—yet we lag behind in reducing hospital mortality rates after heart attack (3). This alone points to overdiagnostics and overtreatment, which is a major problem for end-of-life care (4).

CME articles have a responsibility to promote knowledge to young colleagues as well. In a country of invasive overdiagnostics, the list of possible examination procedures does not appear to be helpful.

DOI: 10.3238/arztebl.2017.0271a

Dr. Matthias Thöns

Palliativnetz Witten e. V., Germany

thoens@sapv.de

1.
Berliner D, Schneider N, Welte T, Bauersachs J: The differential diagnosis of dyspnoea. Dtsch Arztebl Int 2016; 113: 834–45 VOLLTEXT
2.
Stewart S, MacIntyre K, Hole DA, Capewell S, McMurray JJV: More ‘malignant’ than cancer? Five-year survival following a first admission for heart failure in Scotland. Eur J Heart Fail 2001; 3: 315–22 CrossRef
3.
OECD: Health at a glance 2015: OECD indicators.Paris: OECD publishing 2015. http://dx.doi.org/10.1787/health_glance-2015-en.
(last accessed on 23 March 2017).
4.
Thöns M: Patient ohne Verfügung. Das Geschäft mit dem Lebensende. 7th edition. München: Piper 2016 MEDLINE PubMed Central
1.Berliner D, Schneider N, Welte T, Bauersachs J: The differential diagnosis of dyspnoea. Dtsch Arztebl Int 2016; 113: 834–45 VOLLTEXT
2.Stewart S, MacIntyre K, Hole DA, Capewell S, McMurray JJV: More ‘malignant’ than cancer? Five-year survival following a first admission for heart failure in Scotland. Eur J Heart Fail 2001; 3: 315–22 CrossRef
3.OECD: Health at a glance 2015: OECD indicators.Paris: OECD publishing 2015. http://dx.doi.org/10.1787/health_glance-2015-en.
(last accessed on 23 March 2017).
4.Thöns M: Patient ohne Verfügung. Das Geschäft mit dem Lebensende. 7th edition. München: Piper 2016 MEDLINE PubMed Central

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