Medicare-stop care that prolongs pain and sufferring of dying- and save $s

[papau]

http://www.nytimes.com/2005/02/27/business/yourmoney/27view.html

How to Save Medicare? Die Sooner
By DANIEL ALTMAN

Published: February 27, 2005


<snip>
Explaining that principle early on could make a difference in the cases that appear to pose the biggest problem: those in which the patient's health changes suddenly and severely. Dr. Wilensky cited recent research showing that these cases incurred high costs with scant medical benefit.

"When someone starts going south, and there was not an expectation that that was going to happen, you probably pull out all the stops," she said.

These choices can actually harm patients, contradicting the purpose of the treatment, said Dr. Arnold S. Relman, a professor emeritus of medicine and social medicine at Harvard and former editor in chief of The New England Journal of Medicine. "Sometimes, you know that death is inevitable over the next few weeks or few months," he said. "And then there are some doctors, and some families, who just don't want to confront that, and feel that they want to and should invest everything possible - the maximum amount of resources - in fighting the inevitable. That often results in prolonging the pain and discomfort of dying."

Dr. Wilensky said these cases often involved an unusual number of specialists and other doctors visiting the patient, as well as a potentially excessive number of tests. Better coordination of care within hospitals and with other providers could curtail these extra efforts, she said. She also suggested that more use of evidence-based medicine, in which care is guided by documented cases and statistics, could discourage doctors from pursuing treatments with little chance of success.

[Warpy]

1. The problem is that you can't always tell the difference

Those of us in healthcare have seen people who were thought to be moribund, placed on comfort measures only, and who recovered; we've also seen people who were in excellent health before a sudden illness, and who experienced a cascade of problems that resulted in death despite our best efforts.

Most surgeons stop doing anything but emergency procedures on patients over 90; some procedures are no longer done on patients over 80. Even though the person in question may be alert and active, those body systems just won't survive the stress of anesthesia and surgery. They may survive the procedure, but not well and not for long. Emergency procedures are done, of course, when there is a chance of alleviating symptoms and buying them a little more time.

The problem with rigidly adhering to a set of statistics based on age is that some people will always exist outside them. Some people in their 30s will do very poorly after cardiac surgery and some people in their 80s will sail through surgery and recovery and live another 20 years.

[papau]

2. You sound like the medical side of my family (wife and one daughter)

They both reject the idea of "rules" by a government on life saving care.

But the idea that State plans require some limits to care - Oregon style - seems logical.

It is just going to be hard to get to a set rules that discourage cost incurral for unlikely to help procedures while providing good care. The Brit's have their rules - and folks buy private health insurance if they want extra effort.

[applegrove]

3. Are the rovbots trying to lure Medicare pros to be for Euthanasia?

Someone tell me - I am too scared to read the article. That would be one way to get rid of Medicare & get AARP!!

Anyone have a freeper test I can administer right now, right here?

:cry: