We live in a society where the patient expectations of the outcomes by physicians are so often met head on by the unmanaged expectations of families who believe that their 87 year old grandma with Alzheimer's is going to live forever. A lot of families get it. But a lot don't. I think the unmanaged expectations for a lot of those that don't get it are guilt driven, financially driven, culturally driven, media driven and technology driven. I've heard it all.
- "I'm not going to be the one to pull the plug"
- "Keep grandpa alive until midnight so I can collect his disability check for the month."
- "We are entitled to immortality"
- "Everyone walks out of the ICU on television"
- Dr House
We live in a country where so much of our medical care and by default, expenses are directed toward saving what's already dead. Cells that we can crush, squeeze, stent, cut, kill, radiate, burn, and medicate. All our tissues are on a life long journey from life into death. We can't create healthy tissue out of the dead stuff. Yet we spend all our money trying. Almost 2.5 trillion dollars a year. When are we going to wake up and stop paying for death and start funding life. Processes that are proven to prolong active quality lifestyle?
- Calorie control
- Exercise
- Not smoking.
Trying to change the unmanaged expectations of a culture in denial is like trying to get an orthopaedic consultation. The madness will end, one way or another. It will end.
I agree.
ReplyDeleteThe best thing to help control healthcare costs would be a massive public education campaign revealing how futile, dehumanizing and a waste of money so much hospital care is.
Film a code, put a black line over the patient's eyes, show them laying there, nude, in a room full of people inserting tubes into everything and "shocking" the patient.
Film any community hospital ICU, full of copd'ers in their 70's and 80's, intubated, weak, cachectic, unable to talk or eating, laying there in their own feces.
Let the public see the reality. Unfiltered. Force patients to see this before they get sick, so they make their wishes known, and not be at the mercy of unreasonable relatives.
It is not religious; I have privileges at a catholic hospital and we have dnr patients all the time.
We cannot mandate end of life care,that is too Orwellian, or at least too much like Logan's Run. But we should educate people about the realities of futile care. No rational person would want to be in that situation.
Firstly yuck on number two, how callous some people can be they need a boot up the bum for their selfishness.
ReplyDeleteSecondly my Grandmother lived into her 97th year. She had said to me several years before hand, she was tired of living. I respect that. She had all of her faculties, could walk, hear, see, no incontinence and quite independant.
She did fall, have a stroke, suddenly was incontinent. She did end up in hospital, had her C.T, her skull opened to relieve the clot and pressure. Anyway she ended up in a rest home/geriatric hospital, was sat in a chair for months on end with no mobilisation. Bi lateral femoral D.V.Ts later she died slowly from gangrene. The point of this is, my mother didn't want her home, I could tell Nana wanted to be at home where she would pass quicker and in comfort. We would have had nursing help and I offered to stay in the country longer to help nurse her. No, go. Family didn't want to let go of her, she took longer to pass the whole situation was so sad. Sometimes we as family have to let go, so the dying one can let go they see our fear, pain and anxiety and hold on for paternal/maternal reasons. If it was me, I wouldn't want to suffer that way.
"Unmanaged expectations," indeed.
ReplyDeleteSo sorry about your grandmother's experience, N-C.
People need to learn what it means to leave the ICU. You're not going home - you're going to an LTAC for a few more months of meds and wound care until you end up back in the ICU. That's a success.
ReplyDeleteI had a patient with stage 4 lung cancer, comatose, on home hospice brought to the ER today because his wife "changed her mind" and "now wants everything done."
I am forced to wonder if she had to pay for even a small portion of his futile care, would she still feel the same way?
The burden is on the healthcare professionals to convey the grim message to the relatives.
ReplyDeleteHow else would the family understand? How would laymen know that the name of intensive care unit (ICU) doesn't mean it's the place for everything to magically improve?
the problem is, a lot of times when we (healthcare professionals) try to convey the reality the family all too often hear 'you want to kill my ...." 'you give up, we don't...' It's a difficult situation we face (as hospitalist) where we face these end of life situations and meet the patient and/or the family for the first time, they think we work for administration and just want to control spending.
ReplyDeleteExcellent article Happy, You could not have said it better
Second career nursing student again... I remember back in the day when the prog was bad, the family, friends, clergy would be gathered. Docs and nurses somehow had the time and reality was kindly but frankly told all. Questions were answered, support was given and many times the best decisions were then able to be made.
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