Or maybe they really are monumentally busy. In one case, a physician suggested we meet for a chat in the lobby of the Future Nissan of Roseville in the Auto Mall while his car was being worked on. After turning his car over to mechanics, the medical director for the Sacramento and Roseville Kaiser Permanente hospice apologized for the offbeat interview location, with its roaming salesmen and soft-rock soundtrack, and proceeded to tell the story of Sophie.
An year-old African-American woman, Sophie not her real name checked into Kaiser a few months back with a history of rapid weight loss and an infection called sepsis, said GuntherMaher. We scanned her abdomen … and we found a mass. Initially, Sophie said she wanted the doctors to do everything possible to save her life, said GuntherMaher.
It was a desire to help make order out of such end-of-life turmoil that led GuntherMaher on the path to his current post at Kaiser. This state of mind, he said, often lays the ground for patients or their families to go for whatever procedures are offered, however aggressive.
Like every other physician we spoke to, GuntherMaher believes patients should be able to choose for themselves whether or not to undergo treatments near the end of life. What is a life? What is death? Nobody else in our society is, except maybe pastors. Physician Orders for Life-Sustaining Treatment forms state what kind of medical treatment seriously ill patients—usually already in the hospital or a nursing facility—want for themselves.
When my time comes, I want to die in my own home. The place has the ambience of a modern airport terminal, with its long median aisle, high-ceiling skylights, stylish design and chairs positioned in rows around stations with smiling receptionists.
Surprisingly, Woodland Healthcare a service of Dignity Health houses a newish Yolo County medical complex that even includes a classroom. Jeffrey Yee stands before his students—gray button-down shirt, khakis and a pocket pager—with all the friendly charisma of a social-science professor. Yee, who testified in on behalf of POLST before the state Legislature, led his students through a PowerPoint presentation on advance directives and the importance of naming a health-care agent or proxy. He and a nurse practitioner even performed a skit where the two played siblings with different interpretations of what a doctor recommended should be done with a mom on life support.
Nor does he discuss specific procedures and their possible outcomes. Follow us on twitter. Video Insights. Gregg Sylvester, MD, MPH, chief medical officer, Seqirus, discusses the findings of a recent study showing that Fluad Influenza Vaccine, Adjuvanted was more effective than nonadjuvanted and high dose influenza vaccines at reducing medical visits for older adults of at least 65 years of age.
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Specialties Autoimmune. Clinical Pathways. Population Health. Public Safety. Wound Care. Publications Addiction Professional. Behavioral Healthcare Executive. Cath Lab Digest. EP Lab Digest. IO Learning. Journal of Clinical Pathways. Journal of Invasive Cardiology. Podiatry Today. Psych Congress Network. The Dermatologist. Today's Wound Clinic. Vascular Disease Management. Advances in Inflammatory Bowel Disease.
The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist.
I have even seen it as a tattoo. To administer medical care that makes people suffer is anguishing. The simple, or not-so-simple, answer is this: patients, doctors, and the system.
To see how patients play a role, imagine a scenario in which someone has lost consciousness and been admitted to an emergency room. As is so often the case, no one has made a plan for this situation, and shocked and scared family members find themselves caught up in a maze of choices.
Then the nightmare begins. The above scenario is a common one. Feeding into the problem are unrealistic expectations of what doctors can accomplish. Many people think of CPR as a reliable lifesaver when, in fact, the results are usually poor. If a patient suffers from severe illness, old age, or a terminal disease, the odds of a good outcome from CPR are infinitesimal, while the odds of suffering are overwhelming. Poor knowledge and misguided expectations lead to a lot of bad decisions.
Doctors play an enabling role, too. The trouble is that even doctors who hate to administer futile care must find a way to address the wishes of patients and families. Imagine, once again, the emergency room with those grieving, possibly hysterical, family members.
They do not know the doctor. Establishing trust and confidence under such circumstances is a very delicate thing. People are prepared to think the doctor is acting out of base motives, trying to save time, or money, or effort, especially if the doctor is advising against further treatment. Some doctors are stronger communicators than others, and some doctors are more adamant, but the pressures they all face are similar.
When I faced circumstances involving end-of-life choices, I adopted the approach of laying out only the options that I thought were reasonable as I would in any situation as early in the process as possible.
A study published in The New England Journal of Medicine found that CPR as portrayed on television was successful in 75 percent of 60 cases and that 65 percent of the patients went home. In contrast, in a study of more than 95, cases of CPR in Japan, health professor Hideo Yasunaga and fellow researchers found that only 8 percent of patients survived for more than one month. Of these, only about 3 percent could lead a mostly normal life.
Hospitals cannot help with most of these things. Unfortunately, most patients do not see their wishes fulfilled. A study published in the Journal of the American Geriatrics Society looked at Medicare patients and found that, while most said they preferred to die at home, most died in hospitals.
I discussed the tense, and often tragic, circumstances that surround many of the treatment decisions made in hospitals. Often, I noted, family members or medical staff effectively override the wishes of a dying patient. A study published in the Journal of Clinical Oncology found that most patients and families agree in theory that patients should make their own end-of-life decisions, but in practice about half of families override the stated preferences of patients.
They have disagreements about the use of life-sustaining measures, and they lack written documents to resolve the matter. Such stories are one reason doctors hate to make predictions.
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