Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

End of life care is too complicated

Gene Uzawa Dorio, MD
Physician
June 5, 2013
110 Shares
Share
Tweet
Share

Advancing technology has allowed life to be simple. Nowadays, when you go shopping, you slide a credit card and voila, sold. Why does it seem though some things are getting more complicated?

Dioctyl sodium sulfosuccinate is another name for Colace. We are forced to have two names for one drug: a brand name, and a generic. The pharmaceutical companies tell us they have patents mandating we live in their complicated world, and I tell them my patients get confused and face life-threatening errors from their multi-nomenclature lingualese.

There are certain nonnegotiable facts of life we expect, most markedly: death and taxes. Not surprisingly, federal tax codes comprise 20 volumes and over 73,000 pages, and this doesn’t include those for your state. Death used to be easy, but we have successfully made this final act more complicated.

Having a will seemed simple in the past. Now we have power of attorney, advanced health care directive, do not resuscitate, living trust, five wishes, POLST, probate, and a myriad number of other terms forcing some of us to even reconsider death. There are two subjects I want to discuss which even medical professionals have difficulty defining: palliative care and hospice care.

Please, Google their definitions and although you’ll find hospice seems straight forward, when to initiate palliative care is ill-defined. Presently, my right big toe, a chronic curable problem, could be under a palliative care multidisciplinary team of experts resulting in advice to stop running.

The experience of doing housecalls and working on the frontline in geriatrics, while observing and medically managing end-of-life patients, has allowed me to watch the process of going from active and vibrant, to bedridden and demented. Everyone deteriorates physically or mentally, yet each of us follow our own road at different rates.

Generally speaking, when you are 75-years-old and admitted to a hospital with a medical problem, there might be 20 options of studies and treatments that get you better. When you are 85-years-old, you might have 10 options, and at 95-years-old, you might be down to 5 options. Reality is, there is a point in life where you have only one or two options to get you better, and there is a possibility you might have none.

Palliative care should begin when we are faced with minimal options. There might be pain and discomfort, but usually these symptoms can be relieved to maintain quality of life. Testing (including labs, scans, x-rays, etc.) and even hospital admissions are still possible, but this decision comes from frank discussions among physician, patient, and family balancing risks and benefits. There are no death panels or rationed care. Should there be a new medical breakthrough with potential cure, an option to pursue it would be given.

When physical or mental pain, discomfort, and suffering become unrelenting and quality of life is significantly diminished, hospice is offered assuring intensified end-of-life care.

The present ill-defined terms of palliative and hospice care have allowed certain profiteering healthcare organizations to sever their obligations by convincing patients and families to put their loved ones on hospice care. The organization saves money by not doing an appropriate workup for the disease, and financially washes their hands of the patient.

Further blurring this issue are the words comfort care offered by hospitals as a euphemism for hospice sowing terminology intentionally confusing the public. Wouldn’t you want a high degree of comfort care at any time for your loved one?

The medical profession must be vigilant of potential exploitation to keep our elder seniors out of harm’s way. Creating well-defined standards and criteria for palliative and hospice care may help make complicated end-of-life decisions simpler. As a merciful society, we are obligated to move forward in our efforts, so when it is my turn and I’m down to no options of life, I want my final question to be: “Where do I slide my card?”

Gene Uzawa Dorio is an internal medicine physician.

Prev

Letting your infant cry it out: Will it hurt your baby?

June 5, 2013 Kevin 3
…
Next

Why this pediatrician is worried about Snapchat

June 5, 2013 Kevin 6
…

Tagged as: Palliative Care

Post navigation

< Previous Post
Letting your infant cry it out: Will it hurt your baby?
Next Post >
Why this pediatrician is worried about Snapchat

More by Gene Uzawa Dorio, MD

  • Next of kin in the medical decision making process

    Gene Uzawa Dorio, MD
  • The nursing home crucible

    Gene Uzawa Dorio, MD
  • Making medical decisions without accountability 

    Gene Uzawa Dorio, MD

More in Physician

  • Unlearning our habits: a journey from intelligence to wisdom

    Brian Sayers, MD
  • Beyond pizza and pens: National Doctors’ Day should be about saving lives

    James Young, MD
  • Maximizing physician potential: How coaching can aid in conflict resolution, enhance health care leadership and build stronger teams

    Asha Padmanabhan, MD
  • Physicians are a finite resource we need to protect

    Jack Resneck, Jr., MD
  • Tom Brady’s legacy and the importance of personal integrity in end-of-life choices

    Kevin Haselhorst, MD
  • The hidden truths of hospital life: What doctors wish you knew

    Emily Stanford, DO
  • Most Popular

  • Past Week

    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • Beyond pizza and pens: National Doctors’ Day should be about saving lives

      James Young, MD | Physician
    • Physicians are a finite resource we need to protect

      Jack Resneck, Jr., MD | Physician
    • From clocking in to clocking out: the transition to retirement

      Debbie Moore-Black, RN | Conditions
    • From hope to heartbreak: a story of loss in the ICU

      Ton La, Jr., MD, JD | Conditions
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
  • Recent Posts

    • From hope to heartbreak: a story of loss in the ICU

      Ton La, Jr., MD, JD | Conditions
    • Unlearning our habits: a journey from intelligence to wisdom

      Brian Sayers, MD | Physician
    • Lessons from an orthopedic surgery journey [PODCAST]

      The Podcast by KevinMD | Podcast
    • Beyond pizza and pens: National Doctors’ Day should be about saving lives

      James Young, MD | Physician
    • Maximizing physician potential: How coaching can aid in conflict resolution, enhance health care leadership and build stronger teams

      Asha Padmanabhan, MD | Physician
    • The future of education: AI empowerment, YouTube college credits, and the impact on traditional colleges

      Harvey Castro, MD, MBA | Tech

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 6 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • A Drink or Two a Day Won't Help Prolong Life
  • Sleep, Exercise, and Death; Pope Improving, Eats Pizza; Obesity Med Strategies
  • U.S. Study Backs 'Helper' Virus Theory in Kids' Mystery Hepatitis Cases
  • Moderna's Steep COVID Vaccine Price: Corporate Greed or Capitalism?
  • House Republican Argues Against FDA Budget Increase

Meeting Coverage

  • VTE Risk in Recurrent Ovarian Cancer Increases With More Lines of Chemotherapy
  • Obesity's Impact on Uterine Cancer Risk Greater in Younger Age Groups
  • Oral Roflumilast Effective in the Treatment of Plaque Psoriasis
  • Phase III Trials 'Hit a Home Run' in Advanced Endometrial Cancer
  • Cannabis Use Common in Post-Surgery Patients on Opioid Tapering
  • Most Popular

  • Past Week

    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • The untold struggles patients face with resident doctors

      Denise Reich | Conditions
    • Beyond pizza and pens: National Doctors’ Day should be about saving lives

      James Young, MD | Physician
    • Physicians are a finite resource we need to protect

      Jack Resneck, Jr., MD | Physician
    • From clocking in to clocking out: the transition to retirement

      Debbie Moore-Black, RN | Conditions
    • From hope to heartbreak: a story of loss in the ICU

      Ton La, Jr., MD, JD | Conditions
  • Past 6 Months

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • It’s time for C-suite to contract directly with physicians for part-time work

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD | Physician
  • Recent Posts

    • From hope to heartbreak: a story of loss in the ICU

      Ton La, Jr., MD, JD | Conditions
    • Unlearning our habits: a journey from intelligence to wisdom

      Brian Sayers, MD | Physician
    • Lessons from an orthopedic surgery journey [PODCAST]

      The Podcast by KevinMD | Podcast
    • Beyond pizza and pens: National Doctors’ Day should be about saving lives

      James Young, MD | Physician
    • Maximizing physician potential: How coaching can aid in conflict resolution, enhance health care leadership and build stronger teams

      Asha Padmanabhan, MD | Physician
    • The future of education: AI empowerment, YouTube college credits, and the impact on traditional colleges

      Harvey Castro, MD, MBA | Tech

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

End of life care is too complicated
6 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...