Wednesday, July 7, 2010

Heatlhcare Dollars Part 2

OVER-TREATING: is where the money goes down the toilet. End of life care.

From the article..."More than 80 percent of such patients say they want to avoid hospitalization and intensive care when they are dying, according to the Dartmouth Atlas Project. Yet the numbers show that's not what is happening: The average time spent in hospice and palliative care, which stresses comfort and quality of life once an illness is incurable, is falling because people are starting it too late. Hospitalizations during the last six months of life are rising. Treating chronic illness in the last two years of life gobbles up nearly one-third of all Medicare dollars."

Half of what we see in the ER is old nursing home gomers trying to die but their families won't let them. So lets just keep fighting so demented old grandma can sit in her chair in the nursing home some more and see them briefly on holidays. It is ridiculous.

Cancer sucks. If you have bad cancer and you are 75...and the treatments aren't working...hang it up and spend your time being comfortable.

I heard a story from a surgeon the other day: An illegal immigrant was shot while committing a crime. He was a vegetable in the trauma ICU. There was no one to "legally" execute a withdrawal of care for this ILLEGAL CRIMINAL IMMIGRANT, so he stayed on a ventilator in the ICU for a year....gobbling up who knows how much money. Finally after a year, the hospital ethics committee and a court agreed to pull the plug on the guy...and he passed shortly after. Glad my tax dollars are well spent.

Long story short.....let's rethink end of life care. Get past all the sensitivities and lets make some progress.

-ER Doc


GrumpyRN said...

I absolutely agree with you on this - even though I have no vested intrest living in the UK.
But, you are so going to catch it from the 'thats introducing death squads, you are killing off grandma' people.

Anonymous said...

And this is how lawyers can help with rising healthcare costs. I do estate planning. I also do low-cost, basic estate planning for normal people, who don't have big estates. For those people, a major part of estate planning is holding their hands while they make their decisions about end of life care and talking to them about talking to their family members, sometimes helping with those conversations, and ensuring that the client has a strong plan, not just a wish, for their end-of-life care and most importantly, has included their family in their plans. Communication in advance of the health crisis is key.

I should get around to posting a name already, I seem to be becoming a regular commenter. Same anon. as yesterday.

kds said...

It is awful that we would allow an illegal immigrant to "stay alive" for that long. I hate health care. We will allow for this to happen but our health care providers won't cover thing's such as inferitilty costs and cancer treatments. Wouldn't it be nice if what we pay in taxes actually benefited those that are paying it??

jillian said...

Man, this is why we DO need "Death Panels" -- because we DO need to be asking people how they want to die, and getting them to think about it and talk to their families about it. Nobody should die in the hospital unless they had a car accident or something.

I get to say that because my husband had an awesome death, at home under hospice care, exactly how you would want it, except for the fact that he was 39 and not 105. Everybody dies, people! You want to do it peacefully, not in the yucky hospital!

ERP said...

Maybe they had the right idea in "Logan's Run".
Seriously though, I totally agree with you.

Anne said...

We had this patient two weeks ago.....her family was more concerned about an eye problem than the fact that she has cancer EVERYWHERE!!! Without a doubt, I will haunt my children if they EVER keep me alive like that!

Rebecca said...

I can see the problem of the expenses of pointless end of life care. But why does the patient being an ILLEGAL CRIMINAL IMMIGRANT make the situation worse? Are they less human and less entitled to dignity?

(Pretty sure what your answer will be.)

SerenityNow said...

Criminal illegal immigrant. Shouldn't have to spend all that money and resources for these cases. Should let them go bc it's our tax money supporting a criminal and illegal from another country. Maybe stabilize and ship to a hospital in their own country. So yes, basically they should have less human rights when it involves this much money and resources.

-ER Doc

GrumpyRN said...

I said I agree with your premise that end of life care needs to be thought through, but I absolutely cannot agree with "So yes, basically they should have less human rights when it involves this much money and resources".
Human rights are human rights, you have to give them or you do not desrve them for yourself. Who makes the decision to remove human rights, and which rights do you remove? Do we remove your right to free speech because I don't agree with what you say? Do we remove prisoners rights because they are held in another country and kept blindfolded and tortured? Oh, wait, America has already done that with Guantanamo and Abu Ghraib. Yes I know UK is not lily white and I am not pretending otherwise. I would go further but I would then be invoking Godwin's Law.
No, when you unilaterally remove someone's human rights then you remove the humanity from yourself.

SerenityNow said...

So it basically goes back to the question is healthcare a right or a privilege

ER doc

Btw grumpy thanks for reading all the way from England that's pretty cool. Wish we had your system.

Rebecca said...

Healthcare is a right as something that is essential to human dignity. The problem comes in when it's not being used to preserve that dignity but instead create some grotesque mockery of life. But that has nothing to do with immigration, class, or racial status.

GrumpyRN said...

Unfortunately, it depends on where you live. In UK, health care is a right, in US health care seems to me to be a privilege. My personal opinion....? I think it should be a right but with all members of society contributing - but then being British and working in the NHS I would say that. Although I sometimes wonder when some 18 year old who is unemployed tells me he pays my wages because his dad pays taxes.

In UK your illegal immigrant in ICU would have his treatment continued or withdrawn based on his outcome. A decision would be made by hospital staff on medical grounds to extubate and it is unlikely a court would be involved.

kds said...

I don't know if health care should be a right or not. I think as of now, the way it works is shitty. I mean, if you make under a certain level, your health care is paid for. You get free groceries, breaks on child care and other things that the government just gives to these people. Why would someone getting all of this want to make more money?? That's a whole different argument though. Middle class America doesn't always have the money to pay for health insurance. They have to use that money for groceries and things that NEED to get by. I just thinks the system is screwed right now... guess we will see how this new thing works out.

Anonymous said...

Health care is a right that comes with responsibilities. Freedom is a right, but you lose it if you commit a crime. Shouldn't you lose some of your health care rights if you are irresponsible with your own health, like you smoke, or you won't put down the cheeseburger and take a walk, or you get yourself shot committing a crime?
Love you guys!
Anonymous Pathologist

Anonymous said...

A friend's father is in hospital right now. He's a 75-yo lifelong alcoholic with gout, incipient kidney failure, an enlarged prostate, an elevated white blood cell count and no one knows why, PLUS he needed a triple bypass--he called 911 when the chest pain got too bad. After stabilizing his kidneys and everything else, guess what--he got the triple bypass. What a waste of money. I bet that he dies within 6 months, but the family insisted.