Tuesday, December 4, 2012

Seven Harms from Over-treatment in the ICU

There are at least seven discrete harms from over-treatment in the ICU:
  1. Patient - The patient's autonomy is violated, because she is not getting treatment consistent with her preferences and values.
  2. Patient - The patient will likely physically suffer from this over-treatment. 
  3. Nurses - The nursing staff will likely experience moral distress.
  4. Other Patients - The anxiety of the nursing staff can adversely impact their care of other patients.
  5. Other Patients - Over-treating patients in the ICU means that other patients in need of that level of treatment will be boarded in the ED or elsewhere, increasing their risks.
  6. Other Patients - over-treating can 'incubate' multi-drug resistant infections.
  7. Society - Much over-treatment is billed to public payers like Medicare that we pay for but really cannot afford.

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1 comment:

  1. AnonymousDecember 4, 2012 at 4:38 PM

    Excellent conclusions as to the harm done by overtreatment of patients by their physicians.

    BUT, of course, until the OVERTREATMENT of mostly elderly and Medicare/Medicaid qualified patients is recognized and stopped under LAW and with the cooperation of the American Medical Association, overtreatment will continue to be UNRECOGNIZED -- and remain fiscally expedient for physicians AND hospitals under current laws that reimburse physicians and hospitals up to the Diagnosis Related Group CAPS for the conditions being treated.

    Because Medicare and the private insurers already do not reimburse for NON-beneficial
    over- treatment of patients or mistakes or errors or failure to indicate conditions Present on Admission to the Hospital, many patients are being sacrificed to fiscal expediency with the covert and overt introduction of the UNILATERAL DNR Code staus in the Hospital Charts. This hospital code status, of course, enables hospitals to keep mostly elderly/terminally ill patients out of expensive ICUs.

    Let's get all of the truth out there and do something about it. At age 85, if I go to the hospital I want "full code" treatment until my physician informs me that is it absolutely futile and I understand and agree that I am better off dead! ---under the terms of the 1991 Patient Self Determination Act.

    We urgently need an Executive Order or a Mandate from Health and Human Services to physicians that requires them to SEEK informed consent for either Palliative Care OR Curative Care from their
    elderly patients with late-stage diseases.

    Elderly patients with late stage illnesses are NOT being informed of the intelligent option of doing nothing through the process of informed consent for either palliative care or curative care.

    Obviously, doctor-patient discussions about end-of-life choices should include discussion of whether or not the patient wants to receive life-saving and life-extending treatments during the palliative treatment stage of their diseases.

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