Wednesday, June 30, 2010

Are We Appropriately Treating Dying Patients?

We have the best healthcare system in the world for treating patients with serious injury or disease. We don't do so well keeping patients healthier in the first place but that has been covered in a previous post. The problem with out current treatment system is that we do not know how and when to appropriately turn it off and allow a dying patient just to pass on in comfort and peace.

Dr. Martha Twaddle, Chief Medical Officer of the Midwest Palliative and Hospice Care Center in Chicago states that doctors usually know when an illness is incurable yet they continue to practice exhaustive medicine on these patients until there are no treatment options left. It is only when the patient is adamant they they wish to die in peace that the comprehensive arsenal of technology and drugs are withdrawn.

Even though over 80% of patients with progressive chronic illnesses say the want to avoid hospitalization and intensive care when they are dying, most do not get their wish. A study of Medicare patients shows that hospitalizations have risen over the last 10 years for these patients during their last six months of life. They also found that nearly one in three Medicare dollars is spent on patients treating chronic illnesses during their last two years of life.

I think that the suggestion of stopping appropriate medical treatment for a patient with two years life expectancy is going too far. But clearly we can declare patients as hospice candidates earlier than we are doing now. While the number of end of life hospitalizations has increased, the average time spent in hospice has gone down. One in three hospice patients had it for only a week or less when they died. This is a shame because hospice stresses comfort and quality of life which for the incurable is far more important than extending the body's physiological functions with machines.

It will probably be a cost cutting initiative that will reverse this trend rather than doing what is really best for the patient. Either way, we can be proud of our life saving technology and drugs, but lets use them on the lives that can truly be saved.

More on this later.

Mark Brodeur

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