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Hoppy’s Commentary for Thursday

In 2009, when my father was dying from COPD (chronic obstructive pulmonary disease), doctors continued to perform tests. The doctors were doing their job and trying to keep my father alive, but the tests were costly and painful for him.

My father finally called off the testing.  He and our family began the painful process of accepting the inevitable.  We called in Hospice.  Within weeks, my father had passed peacefully at home.

At the very end, this 87-year-old man was able to exit on his own terms, with decision-making power and his dignity intact, all the while saving Medicare from any more expensive and ultimately unnecessary tests.

End-of-life care is controversial.   The public policy debates tend to play to the extremes, from fear of “death panels” to promises of new treatments that extend life.  Sometimes lost is the fact that we’re all dying and there should be some reasonable and manageable way to exit gracefully.  

Doctor Ira Byock, the director of palliative medicine at Dartmouth-Hitchcock Medical Center in Lebanon, NH, has been having candid end-of-life discussions with patients and their families for the last 34 years.  He says there are ways to be honest with sick patients without destroying their hopes.

“Difficult decisions are often made in moments of crisis and based on nonmedical factors, such as a patient’s fear, a doctor’s ego, or a family’s unresolved issues,” Byock told Prevention magazine.  “Face the fear, set ego aside, address the problems.”

That approach, Byock says, empowers patients to weigh options realistically and decide how to spend their remaining time. In fact, Doctor Byock believes effective palliative care, instead of repeated tests and heavy drugs, may actually extend the life of the patient.

Meanwhile a group of nine medical specialty boards have come together on a project called Choosing Wisely to develop a list of 45 common tests and procedures that doctors should consider not doing as a way saving money and avoiding needless patient suffering.

According to the New York Times, the list includes procedures such as EKG’s during a routine physical, M.R.I’s for minor back pain, imaging scans for routine headaches, cardiac scans for low-risk patients and CT scans for someone who has fainted, but exhibits no other neurological problems.  

The doctors believe limiting these tests will help reduce the estimated $700 billion that’s wasted every year on unnecessary tests, medical procedures that don’t work and care that adds nothing to quality of life for a terminally ill patient.

Christine Cassell, president of the American Board of Internal Medicine, which coordinated the Choosing Wisely effort, says this is not about rationing. “This is an important discussion about how we can manage the rising costs of care,” Cassell said.  “In fact, rationing is not necessary if you just don’t do the things that don’t help.”

 

Naturally, doctors and hospitals willing to pull back on some of their testing and procedures are going to want protection from lawsuits.  The Choose Wisely group believes that implementing these new guidelines as best practices should do that. 

 

Everyone wants first-rate healthcare, for themselves and their loved ones.  However, even the best care has limits, both financial and in the ability to heal or help.  The public policy debate needs to be as honest as Doctor Byock’s discussions with his patients. 

 

That kind of truth has its own healing power. 

 

 

 

 

 

 

 





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