Health care decisions: A view from the bedside

  • Article by: Thomas Gilliam
  • Updated: February 28, 2013 - 6:21 PM

Everyone involved in health care should spend time at the bedside and see how decisions are made.

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FrankLFeb. 28, 13 8:35 PM

I too have spent time with the health care system with close relatives who just wanted to die peacefully. What I noticed is that the doctors either wanted to do heroic, complicated procedures or nothing. There seemed to be no in-between courses of action. My own mother was a good example, all the symptoms indicated advanced pancreatic cancer, but the biopsy was inconclusive. She couldn't get hospice care because there was not iron clad proof, but to prove it would have required invasive surgery that would have killed her. I asked the doctor a simple question: how would the treatment differ if you knew for sure. His answer was the treatment would have been the same. We took her home so she could get her final wish and die in peace in her own bed. We need the middle ground in treatment, both for cost and quality of life.

rlwr51Feb. 28, 1311:46 PM

I have seen multiple instances - most of them good. However an aunt recently died because the nursing home doctor basically bullied into signing onto hospice because he did not want to readmit her to the hospital to treat her pneumonia, he got her to sign hospice papers when no relatives were around - so he had a paper to cover his butt. When family on her health care directive objected - she was already unresponsive from morphine and were told that those on the health care directive had a say if she was unable to make decisions and she had signed those papers of her own free will, which was totally against what she had said just a few days before - She was also about a month from running out of her own money and was just about to start the process of medicare payments to the home. He listed the cause of death as cancer, which had been in remission for 3 years - he also never consulted the oncologist. He said that that was not routine.

furguson11Mar. 1, 1312:58 AM

"If you have an expensive and finely tuned hammer, problems are more likely to look like a nail." This holds true in most industries.

owatonnabillMar. 1, 13 6:37 AM

Intelligent decision-making in times of stress is never easy, and the time constraints involved with some diseases puts on that much more pressure. Two things that people should do before this issue is forced upon them can help. First, have a family doctor--someone who you see on at least an annual basis who is familiar with you and your needs. If and when something major DOES strike, your doctor can help you make your decisions regarding care and treatment. Second, prepare an advance directive (living will) and have a current copy included in your records with your family doctor as well as with the person or people you designate in your directive as your substitute decision-maker (should you become unable to make an informed decision about your medical care). Again, it is important that people do this BEFORE the stress of major health-care decision-making is thrust upon them. No one likes to think about acute life-threatening conditions, but making some preparations in advance can make that time a bit less stressful for all concerned.

ztwoodsMar. 1, 13 7:49 AM

Everyone needs to read the Time magazine expose' on our health care system and it's associated costs. We truly have the most dysfunctional "healthcare" system in the industrialized world.

crystalbayMar. 1, 13 1:22 PM

ztwoods: The Time expose' is stunning, alarming, and paints a picture of a medical freight train upon which we are all hapless passengers. The enormity of the profit-driven system makes the military industrial complex pale in comparison. For instance, how many uninsured patients are aware that the astronomical bills they receive are viewed by hospitals as a "starting BID" and that only a savvy consumer can push back and lower the bill. These bills are not unlike a divorce settlement in which the system is pitted against the lone patient. Questioning the $5 charge for each little paper cup in which pills are delivered is not made known to the patient.

regionguyMar. 1, 13 4:33 PM

Yes, surgeons can indeed be cut-happy. Sometimes it is for monetary reasons, I am sad to say, but something to remember is that surgeons generally use procedures which they have seen work and/or for which there is some evidence. That doesn't mean it is always the best choice, or the best choice for the particular patient, of course. And fortunately we are getting better at sifting and applying good evidence. Oh, and just to be fair: to healthcare administators, doesn't every medical procedure look potentially unnecessary?

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