In a column, yesterday, in the LA Times, David Lazarus asks "do we really want to spend hundreds of thousands of dollars extending the life of a person with a terminal illness?" "How much money and medical resources are too much when it comes to prolonging a doomed existence? Who decides when your time is up?"
Interestingly, Lazarus concludes that "this is a matter for medical experts, not insurance bean counters, to address. A doctor is in the best position to determine what's most appropriate for his or her patient."
I had rather thought that the overwhelming consensus was just the opposite. Physician practice patterns are quite strongly guided by the reimbursement incentives. So, too often, if it's paid for it will be bought -- whether it is wanted by the patient, whether it is beneficial for the patient.
2 comments:
Pope: I had rather thought that the overwhelming consensus was just the opposite. Physician practice patterns are quite strongly guided by the reimbursement incentives. So, too often, if it's paid for it will be bought -- whether it is wanted by the patient, whether it is beneficial for the patient.
Amen. I would only add that, in this specific case, the money apparently bought this relatively young man a few quality years of life - not just a couple more months of semi-consciousness in a hospital or long-term care facility with intermittent pain.
What is sometimes overlooked is that hospice - especially when it is utilized early enough - often increases a patient's survival time as well as their quality of life.
Romm: Where do you get the statistics to prove that "hospice - especially when it is utilized early enough - often increases a patient's survival time as well as their quality of life."
It would appear that Hospice would shorten the survival time in that palliative care is not agressive at all in terms of monitoring the systems of the body to look for trouble or to avoid trouble.
The great majority of patients NEVER again see a Doctor once they go on Hospice care. The RN in charge of the case makes the decisions and it is his/her goal to keep the patient comfortable and OUT of the hospital.
Again, can you deny that the primary purpost of Hospice and Palliative Care is to permit patients to die at home and to avoid the costs of ICU, etc.. in inpatient care.
I agree with Professor Pope about the physicians who provide care and would further state that because they do treat "terminal" patients, they should have a legal duty to disclose the "futility scenario" to their patients --especially their elderly patients on Medicare, when they recommend treatment regimens. .
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