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!).
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.