Enough is Enough!

It started with our loopy ex-Lieutenant Governor Betsy McCaughey, then spread to Palin and Boehner. After a quiet several months, conservative columnist Cal Thomas is again raising the fear-mongering flag of “death panels” (cue the scary music!).

(http://www.democratandchronicle.com/article/20110103/OPINION06/12300353/1033/OPINION01/Cal-Thomas–She-told-us-so)

What happened? President Obama circumvented the naysayers by adding reimbursement for end-of-life care discussions into Medicare regulatory language, thus taking Congressional approval out of the loop. So today, Thomas warned his readers that doctors will soon be pulling the plug on your loved ones.

As Susan Powter used to say, “Stop the insanity!” Here’s a glimpse of the real world:

I’ve been a practicing doctor for nearly 3 decades, and I have engaged my patients in end-of-life planning discussions the entire time. Why? Because our ability to do things to the human body often outstrips our ability to create any meaningful improvement in quantity or quality of life. This is especially true in geriatrics, where the focus of care shifts from curable diseases to chronic conditions, and the goals favor maximizing comfort, functional competence and overall quality of life.

The vast majority of older people I have worked with are thankful to be asked what they want in the event of future illness. This is done in a non-judgmental way, by asking about personal values and goals, and by providing factual data on possible outcomes without trying to bully the person into one decision or the other. The result is almost always a discussion of what not to start doing, rather than what plugs to pull. (I occasionally remind some of the fanatics that the doctor who’s really “playing God” is the one who tries endlessly to keep a body alive when God is calling it home…)

Most older people choose a path that is something less than “do everything possible”. Some still prefer the full-court press. A good doctor engages them respectfully, answers their questions, and ultimately follows their wishes, whatever they may be (except in unusual instances where pressing forward is clearly medically futile).

This issue is not that doctors want to get rid of old people. The real issue behind reimbursement is that it has long been recognized that not enough doctors engage people in these important discussions while they still have the capacity to direct their own care; it is felt that reimbursing doctors for the time spent in these often protracted conversations will add incentive for them not to skip over this important part of the doctor-patient relationship.

In a system where insurance reimbursement increasingly–and disturbingly–favors invasive procedures over actually talking to patients, this is a welcome trend.

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One Response to Enough is Enough!

  1. Karen Overturf says:

    It is kind of crazy, to want to raise a flag over discussions of the normal progression of the life cycle. I can’t imagine anyone who truly believes that doctors are only interested in getting rid of people. Where would the economy be if we “arbitrarily” decided who should live and who should die? The opinion article said that tying reimbursement to advance directives would eventually lead to some bureaucrat trying to make certain decisions for people. I can’t imagine the doctor taking that kind of order seriously! I do think it will lead to making doctors who don’t have that discussion with their patients to do so.

    It’s unfortunate that what many see as a “normal” part of aging, medical interventions, have become so commonplace that they consider death a failure of the system.

    The only really scary thing about this: most people won’t consult a lawyer on the wording, and leave great gaping holes in their end of life wishes. The forms available (at least the ones I’ve seen up to now) are not detailed enough to leave a clear path for action on the part of the family and their medical provider. The best form that could be used would be a “multiple choice” type form with a write in blank.

    The politicization of common sense health care drives me crazy, too. Frankly, I’m tired of hearing about it from the naysayers. I have a feeling that it is more to win an election than to actually “do something” about the bill. Once they get into the individual provisions, I think they’ll leave the bulk of it alone, and improve the parts that need clarification. I hope the media will turn to those who dislike advance directives and ask them, “Have you made an advance directive?” and, on an affirmative answer, “Why? Doesn’t that lead to some bureaucrat making a decision for you?”

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