Comments on: The pointless end-of-life CT scan http://www.kevinmd.com/blog/2006/08/pointless-end-of-life-ct-scan.html Tue, 14 Feb 2012 17:18:00 +0000 hourly 1 By: Anonymoushttp://www.kevinmd.com/blog/2006/08/pointless-end-of-life-ct-scan.html#comment-66538 Anonymous Sat, 26 Aug 2006 01:41:00 +0000 http://clients.emmense.com/kevinmd/2006/08/the-pointless-end-of-life-ct-scan.html#comment-66538 Beajerry: In view of another current and ridiculous situation, I offer this modification of your statement: <br/><br/>The entry hallway into an airport should be a conveyer belt through x-rays, CT scans, MRI's, endoscopy and yes, Colonoscopies.<br/>Only after all that may you board the airplane. Beajerry: In view of another current and ridiculous situation, I offer this modification of your statement:

The entry hallway into an airport should be a conveyer belt through x-rays, CT scans, MRI’s, endoscopy and yes, Colonoscopies.
Only after all that may you board the airplane.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/08/pointless-end-of-life-ct-scan.html#comment-66537 Anonymous Sat, 26 Aug 2006 01:36:00 +0000 http://clients.emmense.com/kevinmd/2006/08/the-pointless-end-of-life-ct-scan.html#comment-66537 The entity that needs to "just say no" is the entity paying the bill. Until taxpayers vote to just say no, the pot will be steadily depleted. Doctors and hospitals have every disincentive to just say no. The fact is that unless a patient has their own personal or family resources they want to voluntarily spend to rule out that 1% chance of the incurable or vegetative-state prolonging condition that would otherwise be missed and expose providers to potential liability, somebody needs to say no. Hospice, rational relatives, and living wills help in the meantime. The entity that needs to “just say no” is the entity paying the bill. Until taxpayers vote to just say no, the pot will be steadily depleted. Doctors and hospitals have every disincentive to just say no. The fact is that unless a patient has their own personal or family resources they want to voluntarily spend to rule out that 1% chance of the incurable or vegetative-state prolonging condition that would otherwise be missed and expose providers to potential liability, somebody needs to say no. Hospice, rational relatives, and living wills help in the meantime.

]]> By: beajerryhttp://www.kevinmd.com/blog/2006/08/pointless-end-of-life-ct-scan.html#comment-66360 beajerry Mon, 21 Aug 2006 16:44:00 +0000 http://clients.emmense.com/kevinmd/2006/08/the-pointless-end-of-life-ct-scan.html#comment-66360 The entry hallway into a hospital should be a conveyer belt through x-rays, CT scans, MRI's, and yes, Colonoscopies.<br/>Only after all that may you see the doctor. The entry hallway into a hospital should be a conveyer belt through x-rays, CT scans, MRI’s, and yes, Colonoscopies.
Only after all that may you see the doctor.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/08/pointless-end-of-life-ct-scan.html#comment-66349 Anonymous Mon, 21 Aug 2006 03:23:00 +0000 http://clients.emmense.com/kevinmd/2006/08/the-pointless-end-of-life-ct-scan.html#comment-66349 Where does the Govt. in the UK just say NO to treating old folks? Dr. Crippen talks quite a bit about the old folks he treats. Where does the Govt. in the UK just say NO to treating old folks? Dr. Crippen talks quite a bit about the old folks he treats.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/08/pointless-end-of-life-ct-scan.html#comment-66340 Anonymous Sun, 20 Aug 2006 18:37:00 +0000 http://clients.emmense.com/kevinmd/2006/08/the-pointless-end-of-life-ct-scan.html#comment-66340 I agree, and yet I order them, too. Into the office comes the very old patient, in their tenth decade sometimes, but with the concerned middle-aged grandson or daughter (or in some cases great-grandson/granddaughter) wanting to know exactly what is wrong with granny. Often the complaints are nebulous and the patient unable to cooperate, if good-naturedly. Old stroke or new stroke or no stroke? Ischemia or no ischemia; vasculitis or no vasculitis, it is sometimes hard to tell. But they came with questions, looking for answers and presumably at least an offer of treatment, even if only to be politely declined. Am I to be the one to say this old person should not be treated since their life expectancy, while not exactly knowable can't be very long, and that a reasonable cost-benefits analysis would suggest stopping right there? Not in this country. So I investigate as I would with anyone else, looking for explanations leading to recommendations that probably will be refused anyway.<br/><br/>This isn't really a moral conundrum. It is all about resources, and those who consume them feeling responsible for their stewardship and conservation, or not. The UK, which is no more a moral wasteland than the USA has a simple way of dealing with this. The government there just says no, and that doesn't seem to be such a problem. Maybe there people don't expect to live forever, or expect that natural death isn't preceded by some decline. I agree, and yet I order them, too. Into the office comes the very old patient, in their tenth decade sometimes, but with the concerned middle-aged grandson or daughter (or in some cases great-grandson/granddaughter) wanting to know exactly what is wrong with granny. Often the complaints are nebulous and the patient unable to cooperate, if good-naturedly. Old stroke or new stroke or no stroke? Ischemia or no ischemia; vasculitis or no vasculitis, it is sometimes hard to tell. But they came with questions, looking for answers and presumably at least an offer of treatment, even if only to be politely declined. Am I to be the one to say this old person should not be treated since their life expectancy, while not exactly knowable can’t be very long, and that a reasonable cost-benefits analysis would suggest stopping right there? Not in this country. So I investigate as I would with anyone else, looking for explanations leading to recommendations that probably will be refused anyway.

This isn’t really a moral conundrum. It is all about resources, and those who consume them feeling responsible for their stewardship and conservation, or not. The UK, which is no more a moral wasteland than the USA has a simple way of dealing with this. The government there just says no, and that doesn’t seem to be such a problem. Maybe there people don’t expect to live forever, or expect that natural death isn’t preceded by some decline.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2006/08/pointless-end-of-life-ct-scan.html#comment-66332 Anonymous Sun, 20 Aug 2006 16:15:00 +0000 http://clients.emmense.com/kevinmd/2006/08/the-pointless-end-of-life-ct-scan.html#comment-66332 And if you had "missed" a head bleed on a 95 year old what "family" would come out of the woodwork accusing you of malpractice. Add onto that a scum sucking attorney ready to make a quick buck. Hence everyone gets a head CT. No matter how stupid. <br/><br/>The fact is we all die and the vast majority of times it has nothing to do with malpractice (except in the legal world). And if you had “missed” a head bleed on a 95 year old what “family” would come out of the woodwork accusing you of malpractice. Add onto that a scum sucking attorney ready to make a quick buck. Hence everyone gets a head CT. No matter how stupid.

The fact is we all die and the vast majority of times it has nothing to do with malpractice (except in the legal world).

]]>