Futile care

Another large driver of health care costs comes under scrutiny:

“The biggest problem here is futile treatment,” he said. “That’s when it’s clear after some time that a patient, under normal medical circumstances, is never going to get better.
“People say there could be a million in one chance of recovery, but we can’t work that way.”

Comments

ObGynThoughts
I heard repeatedly that the last 2 weeks in a person’s live are the most expensive, medically speaking. It is hard to place restrictions here, but sooner or later we will have to think about it, discuss it and eventually do it. Funds are limited, and the cost of healthcare goes nowhere but up and up and up.
KoKo
“Funds are limited,”
Certainly funds are limited for many patients, but does this mean that only the very rich should be allowed a 2nd chance at life?
Anonymous
If funds are so limited, please tell me why gang members from the inner ctiy, who are gun shot victims lacking health insurance end up getting such sophisticated medical care, when the arrive in the ER.
Why not start rationing health care, by starting with these non-paying gangsters?
Aggravated DocSurg
When that GSW victim arrives in the ED, and we pull out all the stops to save him (or her), how exactly am I supposed to know if he/she is a gang banger and not you, your son, or your daughter?
Panda Bear
Koko, we’re not talking about giving people a second chance at life. This is the misconception that people have. I believe we’re talking about the patients with no quality of life before they came to the ICU and no realistic chance that they will ever get better.
I am the ICU senior resident at my hospital this month and conservatively, half of the patients upon whom we expend literally hundreds of thousands of dollars will die in the ICU without regaining consciousness. In fact, most of them don’t have a chance and the best we do is to stabilze them for a while, a week or two, a month, maybe they make it back to the nursing home where they will rot some more before they visit us again.
http://pandabearmd.com/blog/2007/03/20/obels-for-charon/
Happyman
To some degree you have two clear sources of blame for transfer of hopeless demented & vegetative patients to the hospital (and hence the ICU):
1- lawyers (explanation unnecessary); and
2- misinformation from a variety of sources – internet, nightly news, even other doctors e.g. “new hopes” for those with profound anoxic encephalopathy, “intensive rehab” etc. Every extended family has a self-appointed expert on how grandpa in the nursing home is not getting the treatment that he “really needs in order to get better”.
Also, working in a nursing home, I see not too infrequently hopeless patients discharged to us from the hospital for “rehab”.
Anonymous
Yeah, the doctors bear no responsibility for the patients being transferred. They’re just mere paper pushers, scared of their own shadows, Happyman. Why are we paying them so much, again?
And actually, it’s not end of life care that drives up the costs, it’s the inability to pay for it. It doesn’t exactly hurt anyone else if I pay for my own healthcare, and certainly doesn’t increase another’s cost.
Happyman
“doesn’t exactly hurt anyone else if I pay for my own healthcare”
Now when you’re young & healthy, healthcare isn’t that expensive. But later it’s a different story:
when you’re 70yrs old, on medicare, & have chest pain, then to “pay for my own healthcare” will mean an ambulance, ER stay, potentially telemetry, cardiac cath, CCU stay, etc. At that time, you’ll demand the latest & most sophisticated devices, drugs, & doctors. This will run TAXPAYERS somewhere around $100,000. You won’t give a crap who’s paying, as long as it ain’t you. This is the same mentality the AARP crowd has now.
As far as paying the “paper-pushers” so much, with declining reimbursements & dismal prestige of primary care, you are getting your wish – in 10 yrs you will have NPs and PAs mismanaging your chronic diseases (diabetes, htn, etc.). Then you’ll need that cardiac cath & stent when you’re 45 instead of 65yrs old.
Hopefully you won’t die or stroke out in the process.
Carol
Sometimes it is a battle within the family that runs up these outrageous expenses. I was forced to engage the hospital’s ethics committee to allow my father to die – after two weeks in ICU on futile care because the one member of the family who had legal say just wouldn’t let go and face the truth. It was obscene. If you don’t want your family to face these decisions, and maybe not make the ones you would chose, get it on paper, people! Make your choice the legal choice. Don’t make your kid have to go to a hospital committee against her family’s wishes and say “I want my dad to die.”

Futile care

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