Money & Medicine. Futile-care

[sugarwood]

Short summary article and 1 hour video.
Money & Medicine | PBS

This was so good, I am watching it again.

I would be interested in hearing others' experiences on this difficult topic.

[masraum]

I think I made it through to 4 mins. It looks interesting, but I don't think I could watch the whole thing. This sort of thing makes me wonder. The beginning spoke so much about the people getting unnecessary tests and treatment, and I have no doubt that happens. What healthcare is that? Who are these people? Most people I know try to stay out of the hospitals and try to avoid treatment and Drs unless they really have a problem.

I work for a very large company with pretty normal healthcare insurance. It would be expensive for us to get a bunch of extra work done.

I'm sure there's plenty of truth to the video, but it also had the feel of propoganda to me. And that feel always makes me instantly doubt any and all claims made.

[sugarwood]

4 mins. was not enough to jump to conclusions. The subtitle of the show is "A third of all health care dollars are spent in the last two years of life." The show is about costly healthcare when there is little to be gained. ie: The theme centers on the dubious efficacy of end-of-life care. Terminally ill futile care. Not frivolous doctors visits between kids soccer games when you're 50. No one does that, I agree. But that is not what the show is about at all. It's about doctors not being able to simply say that death is natural, and it's ok to die in peace

[jyl]

Didn't watch the show. But I'm aware of the situation. Yes, the biggest part of a person's health care spending will typically be in the last year, even the last weeks, of life, and much of it will be futile.

Did the show suggest any solutions?

[93nav]

You do not know when the "last two years of life" is until after the fact. I know someone who had a stroke and the dr's were discussing 'end of life' issues, 5-6 years later, she is still around and moving (though not as well). I know of another similar situation 2nd hand. And I am not in the age group who would normally have much exposure to this sort of stuff.

Originally Posted by sugarwood

4 mins. was not enough to jump to conclusions. The subtitle of the show is "A third of all health care dollars are spent in the last two years of life." The show is about costly healthcare when there is little to be gained. ie: The theme centers on the dubious efficacy of end-of-life care. Terminally ill futile care. Not frivolous doctors visits between kids soccer games when you're 50. No one does that, I agree. But that is not what the show is about at all. It's about doctors not being able to simply say that death is natural, and it's ok to die in peace

[island911]

We are all terminal. Also, it often take treatment to 'die in peace' - rather than having the cancer (or whatever) give the person a massively ugly painful death.

[DanielDudley]

Maybe, but not a million dollars worth of treatment to extend a life without recovery or quality of life. Sometimes extending a life only extends suffering and lessens dignity.

[HardDrive]

My wife does palliative care as part of her practice. A person can be days from death, zero chance of survival, but if the family asks for the doctors to pull out all the stops to keep the person alive, they are obliged to do so. It's absurd.

[sugarwood]

Money and Medicine

Overuse of C-section. Profit maker and more convenient for hospitals.

Families will keep patient asking on machines even when there is 0% chance of meaningful recovery (neurological mental state)

Cancer Treatment. One study shows that Palliative care lives longer

CAT Scan is 200-500 chest X-rays. *Cancer causing.

Hospitals practice “defensive medicine” to protect from missing the one positive.

Mammogram. **Half of women will have false (+) after 10 years of tests. For example, 2000 women do annual test for 10 years. ***1 will avoid death. 500-1000 will have one false alarm. 2-10 will be over diagnosed and treated unnecessarily

Prostate Screening (PSA) ***Poster boy of over-treatment. **Most findings are benign. 1.3mm men. If find real issue, usually too late anyway. Same mortality rate of screeners vs. non-screeners

[Evans, Marv]

This is an irritating topic for me because of my father's situation in 1991, when he died of cancer. He had colon cancer & had a portion of it removed. While in there, they looked at his liver which had cancer spots on it. They told him (& my mother) about it and said it would most likely continue to spread. Not much later on, it did spread to his brain, optic nerve and other places. They told my parents (both very simple people) if they operated on his brain, he could live another six months. If not, me might live six weeks. Of course my parents opted for the operation. After the operation, he was pretty much a vegetable and died within a week. However they made their $250K+ out of it, which was the going rate around then.

[island911]

That type of medicine is about to change with the tsunami of boomers headed to end of life challenges. That is, hospitals will have more pts than they know what to do with.

[sugarwood]

Originally Posted by island911

That type of medicine is about to change with the tsunami of boomers headed to end of life challenges. That is, hospitals will have more pts than they know what to do with.

The documentary did sort of imply that. When people have too many options, they tend to use them all, even if it makes no sense. People talk about death panels, but if a $10mm operation with a 1% chance of extending life by 20 more minutes is an option, I don't really think emotional family members should be in the position of opting for that. It just makes no sense.

[john70t]

'Letting go' is not part of the human psyche.

But this is often to the personal detriment of the future.
And what they wanted.

[Tobra]

Originally Posted by HardDrive

My wife does palliative care as part of her practice. A person can be days from death, zero chance of survival, but if the family asks for the doctors to pull out all the stops to keep the person alive, they are obliged to do so. It's absurd.

This

We did not have this problem until everyone became disconnected from what the healthcare services they received actually cost.

Cesarean deliveries are driven by medico-legal concerns.

If you think it should change, you need to overhaul the medical malpractice situation. Problem is, the laws are made by lawyers, not doctors.

[intakexhaust]

Originally Posted by Evans, Marv

This is an irritating topic for me because of my father's situation in 1991, when he died of cancer. He had colon cancer & had a portion of it removed. While in there, they looked at his liver which had cancer spots on it. They told him (& my mother) about it and said it would most likely continue to spread. Not much later on, it did spread to his brain, optic nerve and other places. They told my parents (both very simple people) if they operated on his brain, he could live another six months. If not, me might live six weeks. Of course my parents opted for the operation. After the operation, he was pretty much a vegetable and died within a week. However they made their $250K+ out of it, which was the going rate around then.

Can relate. My take is to use your gut feeling, research to the best of ones ability, seek more than a few others opinions. Nor should one be at the mercy of them.

Sadly, many in the cancer 'business' today are worse than the disease itself. I'll add, some of the US leading research and treatment centers are rather aggressive for the business. Note I said aggressive.... not 'competitive'.

Proof is when talking with those in the profession that essentially speak negative to even 'bad rap' other researchers or treatment methods. Get down to the nit grit with them and it'll blow your mind. And to think its among their peers.

[Nickshu]

Originally Posted by Tobra

If you think it should change, you need to overhaul the medical malpractice situation. Problem is, the laws are made by lawyers, not doctors.

You beat me to it...As mentioned above much of this is "defensive" medicine and not improve until we have sweeping malpractice reform.

Originally Posted by sugarwood

Overuse of C-section. Profit maker and more convenient for hospitals.

My BIL is an OBGYN. He has told me he would prefer to do C-sections 100% of the time b/c of the greater control which results in reduced liability. Again will not change until we have malpractice reform.

[jyl]

End of life care seems like an insoluble problem to me.

Families are emotional, uninformed, not paying for the futile care. Doctors and hospitals aren't paying for it either, actually they get paid for it. And politicians scream about death panels to get votes. No wonder granny's last month costs $500K.

When my 99 y/o grandfather got pneumonia and went into a coma, his children and grandchildren were all there. I flew from California. We all agreed to let him die. But not all families would have. Same with my 104 y/o grandmother.

But my 70 y/o stepmother has fought off four different cancers over the past two decades (leukemia, lymphoma, head/neck, and mets), and is now in a clinical trial, Herceptin for HER+ lung cancer. She is active and very much enjoying life. Her care has probably cost well over $1MM.

At the end of the day, I think the only way to limit end of life care is to ration it, either by cost (which will mean that, frankly, most of us will see our spouses or ourselves choose between death and bankruptcy) or by panels of doctors (who will be attacked as death panels).

That's why I asked if the TV program offered any solutions. I've never heard of any, that sounded palatable.