Wednesday, February 3, 2016


Like a lot of my more rambling posts, I'm not sure this one has a real solid point. I came across this link today I really don't know anything about them, but the link popped up on my screen because the scary internet has figured out how to store my preferences and present me with links to catch my attention. And we worry about government spying........

Anyway, I'm in the new job and I've been training with a colleague. We admitted two patients this week who really fit the descriptions mentioned here. As of now, I really don't have a solid answer. I think there is truth in stating that there is a ton of lack of personal responsibility that contributes to many problems such as diabetes, heart disease and so on. Yet, when you look at where the money is actually spent, it seems like a lot of money is really concentrated in certain areas. This week, we admitted a patient who has long standing heart disease, and was diagnosed with dementia as well. They were taken to the hospital for a change from their baseline, and were given a very thorough workup. As I read the hospital notes, one thought was, "Well, this is defensive medicine, or cover your ass medicine". I think, however, this phrase is becoming overused. Given all that this patient had going on, the tests given were not out of the question, provided that the goal was to stop the acute process and turn the patient around. For sake of context, this patient is 89 years old.

I bring this up here because however limited the reach of this group may be, I think discussions about health care need to continue. In the case of this patient, who truly fit the picture of chronic illness, this trip through the ER likely generated a 50k bill that did not need to happen. At 89, an already compromised individual would likely not benefit from treatment for a stroke even if it was discovered. Further, even if the doppler studies revealed significant blockage to the carotid arteries, a surgery to fix them would not improve the already well developed dementia. And, considering this individual had already had previous heart surgeries, another bypass was not going to fix an already damaged heart. On admission, I explained what our treatment plan would be that focused on nothing but comfort, and the spouse of the patient indicated they were 100% on board and glad they had made the decision to choose hospice. While this bill is likely pretty big, I have some gratitude that the family was not encouraged to put this patient on a ventilator, have a feeding tube put in their stomach, and eventually be brought to hospice in six months anyway because they did not get better.

The entirety of our system is basically built on keeping people living as long as possible, no  matter how miserable they may be. When they become chronically ill, we give them a pile a pills and list of foods they shouldn't eat and they are basically miserable. There is plenty to be argued about regarding what makes healthcare so expensive. That said, the population of chronically ill individuals who have several diseases is going to continue growing, as will the cost of caring for them. In the midst of what is going to be a multi decade fight over how we fund healthcare and how we prioritize it, I think that providers and patients need to have discussions sooner on how far they are willing to take their treatments. Surely, many are going to die sooner by not having every last treatment possible. But if said treatment does not buy them any quality of life, now seems like a good as time as any to start having honest discussions and start accepting that it might be far more human AND cost effective to stop demanding that we make everyone live as long as possibly largely because we can.


  1. Aren't cookies wonderful? If not erased they know everything about you where you go your interests and sell the information to like organizations.

    The entirety of our system is basically built on keeping people living as long as possible.

    And the people responsible are generally the family. My wife's uncle, 90. I may have told you this story. He had a stroke. All efforts were made to ensure his continues life. While in the hospital, it was discovered he had heart issues and needed a pace maker. The doctor wanted to wait until he was stabilized and ensure there was no major damage. The daughters, 1 a lawyer and 1 a nurse told the doctor he would put in the pacemaker now. Period or else. He now has a pacemaker.

    How many quality years are left? He's pretty much home bound, unable to travel far.

    And yes Max this is one of many reasons cost so much.

  2. I know an 80 year old woman who had multiple valves replaced in hear heart. She made it through the surgery fine, died in recovery that night, was revived and regained consciousness. She felt terrible for several weeks and had to go back to have her chest opened back up to drain a lot of fluid (this was caused by a medication error). She made it through that procedure OK, but died in recovery again. She was out a long time and it was feared that she had brain damage as her heart rhythm stabilized. She didn't regain consciousness this time for several days as the family contemplated pulling the plug on the ventilator. The decision was made to do it the day she came around. She spoke like a stroke victim for several days as the family prepared for her long term care. Surprisingly, she came around. After about 2 months of recovery, she was able to go back home and continue with her life.

    1. Hey storm.

      And then there is Obama's grandmother with terminal cancer. Replaced her hip. Died 2 weeks later.

      Yours is the exception not the norm.

    2. Yes, it is a miracle that she is alive and functional. She was told to go home and die by her original cardiologist. Her primary doc couldn't stand to watch her suffer so he found a friend to take on the case. She probably has the ability to make it another 20 years now - not sure if she really wants it at this point. I think she has some form of PTSD or something.