Why does a 92-year-old man with less than a fifty-fifty chance of living another year get an expensive colonoscopy? I mean, it had better be a good reason. Rectal bleeding. Something like that.
“It was a screening colonoscopy,” said the consultant, “We removed a polyp.”
According to Panda Bear the four most expensive words in all of American health care are "Just to be safe".
I have used that line frequently. And each time I do, I internally rationalize whether the tests I am recommending will ultimately affect my management decisions for my patients and whether those decisions have the ability to change the outcomes of my patient. If we physicians cannot defend our medical decisions based on sound scientific principles, in the correct clinical scenario, we are part of the problem.
The more we screw America, the more we screw ourselves. If we are going to stick an endoscope in a 92 year old, we are part of the problem.
10 Outbursts:
I miss panda, where is he? Happy, you are developing beautifully, however.
Love the bison pics and all your animal pics
click on the link above, he's back blogging.
I see Panda's been watching "Triumph of the Will" again.... Seriously, substitute "African American" for "92 Year Old Man"..... Still OK?? I mean we all know they aren't as productive as Asians.... As long as we're doin Kidney Transplants on convicted murderers I'll practice the same on an African American, I mean, OLD person as I do on anyone else I have the honor to treat....
Sieg Heil Baby,
Frank, M.D..
The AARP is the biggest lobby organization in the US. Until you convince the boomers that it is their responsibility to their children to stop overconsuming health care you are barking up the wrong tree trying to cut costs in this population. There is no slack in the vaunted guidelines for not screening the elderly for disease, therefor there is no medicolegal cover for a "failure" to do so. The government will never tell the elderly, voting, donating public to shut up and die.
"The government will never tell the elderly, voting, donating public to shut up and die." -- said BladeDoc
And that is a fact.
-SCNS
Then there was this 42 year old guy I saw with weight loss and rectal bleeding who wanted a Colonoscopy.... Would have sent him for one too, except he's GAY, and you know what their life expectancy is, with the HIV-ie and everything... Besides its probably just from rectal trauma anyway.... And Oh yeah, I'm pretty sure he's a smoker... Or maybe it was his Pneumocystis actin up.... Anyway, thats one Colonoscopy this doc ain't orderin....
Frank.
P.S. I'm bein Ironic, like Alanis Morisette...
Having had one of those scopes as a less-than-40yr old (for reasonable indications, btw), my biggest question besides the prevention issue in someone elderly is....well 2 questions:
1)Do we use science(or at least the best evidence we have) to make our decisions at least some of the time? (benefit of colonoscopy clearly decreases with age and risks of the procedure increases with age...current expert opinion recommends screening those with a 10 yr life expectancy)
2) The prep is brutal. Brutal. Brutal Brutal. Can not IMAGINE doing it at age 92. Am I just a wimp?
1:Spiffer, you've gotta lot of nerve complaining about some 92 yr old WW2 vet gettin a scope when you got one in your 30's...What'd they find BTW??? Wait, don't tell me, probably X-rated...
2:Despite advances in technology, we still suck at predicting how long a particular persons gonna live... Michael Jackson shoulda been molesting kids for another 30 years...he was skinny, didn't smoke, physically active...sure, after the fact everyone acts like they knew it was gonna happen, but they didn't...quick, whos the next big name to die??? I'm thinkin Lindsay Lohan...:(
3: The prep won't bother the 92 yr old guy at all, he's demented, remember?? Sure, you might screw with his electric lights some, but you don't make it to 92 without some good underlying protoplasm...
4: I know, why treat someone who's demented??? But by that criteria, most kids under the age of 5 would qualify as "demented", their judgement sucks, they can't think abstractly for s***, and they'll look at you blankly if you ask them what some old proverb means... Wanta save money?? Stop treatin premature births, each one of those kids costs like $50 million. And they get teased mercilessly cause they end up with funny lookin heads...
Frank, M.D.
My 91 y.o. gr.grandfather died after his colon was punctured during a scoping. Not sure of the reason for the scoping, but he was the healthiest, most vital 91 y.o. you could ever hope to be, working in his woodshop, gardening, driving, no cognitive decline at all.
Hey Frank. While you are Seig Hieling around the place (is there a Godwin version a for Blogs???), you might want to actually look at the guidelines.
The U.S. Preventive Services Task Force has recommended that, in most cases, routine colorectal cancer screening should begin at age 50 and end at age 75 years, according to guidelines published recently (Oct '08) in the Annals of Internal Medicine. I think the guidelines before that stopped at 85, which this dude is also over.
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