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politics in Harris County and Texas
100 years ago, the debate of healthcare as a right did not even exist. 100 years ago, there was little more than potions and theories of how to make sick people well. Some worked, some didn’t. The training of the “doctors” was little to non-existent. The cost? Maybe a chicken or whatever you had in the pantry.
There is a vast difference in the medical world of 1945 to that of 2002. Developments within medicine would have been expected but they have been in leaps in the last decades. Diseases that would have almost certainly killed in 1945 to 1950 are now usually treatable and in many instances curable.
Healthcare has become increasingly complex, expensive and successful in many areas of healing and in providing comfort over the last 60 years. Why? Advances in technology and a greater understanding of the amazing body we have been give have led to advances in medicine that were unheard of 50-60 years ago. All of this has come with a steep price tag.
Because of these advances, we find ourselves at a crossroad. How do we make it available to those who need it regardless of their ability to pay? How do we allocate the resources?
Would you be willing to have less, so someone else could have more?
If it is about limited resources, we should start the debate there. One place that should be addressed is the over-utilization of services and technology to reduce the risk of lawsuits or because of patient’s demands for services based on little evidence of improvement or benefit.
I think that healthcare reform should start with the root cause of over-utilization of limited resources to begin to expand coverage for all. Everyone will have to change the way they view and use the healthcare system to get healthcare reform.
My view of over-utilization of services comes from years as a case manager. Here are some areas that I think could be addressed without a change in services that bring benefit and value to people.
I will end this post with a question?
Would you be willing to sacrifice your “right” to have everything you wanted in healthcare no matter the limited benefit so others could have healthcare that has proven benefits?
I am as concerned about the suffering of others as much as I am about my own. How could I not give up my demands for care that may have only a 2-5{997ab4c1e65fa660c64e6dfea23d436a73c89d6254ad3ae72f887cf583448986} chance of making me better for someone to have care that will certainly cure them? Though I don’t want the government deciding this, that is my reason for wanting to move to things that will change over-utilization without government takeover.
We need commonsense approaches that are slow and measured to make this work and not break a system that encourages innovation that is second to none.
Like I said, “if what Sparkle was saying was completely true”. As with most instances of manufactured outraged, it isn’t “completely true”. Turns out that Sparkle is outraged that Olbermann is outraged that Glenn Beck is outraged about the “czars” that President Obama has put in place in his administration. Or something like that. Her basic premise is that it is wrong for Mr. Olbermann to ask people for dirt on Mr. Beck, Mr. Beck’s producer and Fox News’ Roger Ailes. Especially people from DailyKos. And especially since Mr. Beck has long aired his personal failings and couldn’t possibly have more skeletons in his closet because he has, after all, redeemed himself.
So, she is outraged that Mr. Olbermann asked for dirt on those guys. And yet, from her own links, it is easy to deduce what is happening here. Mr. Olbermann posted his plea for dirt on DailyKos Sun Sep 06, 2009 at 10:14:03 AM PDT. And right in the middle of his request is a link to what he says is the reason for it.
This becomes necessary after this in order to prove various cliches about goose and gander, and to remind everybody to walk softly and carry a big popsicle, and most particularly to save this nation from the Oligarhy of The Stupid.
Clicking on his “this” link takes you to, well, this.
As he makes a real impact in pushing conservative fringe attacks on Obama administration officials into the mainstream, Glenn Beck’s Twitter feed has become a must-read. In a message from last night, Beck told his followers to “FIND EVERYTHING YOU CAN ON CASS SUNSTEIN, MARK LLOYD AND CAROL BROWNER.” They are, respectively, the nominee to head the Office of Information and Regulatory Affairs, the Associate General Counsel and Chief Diversity Officer of the FCC, and the Assistant to the President for Energy and Climate Change. Browner was also administrator of the EPA for all eight years of Bill Clinton’s presidency.
And then clicking on the link in that paragraph takes you to Glenn Beck’s tweet sent at 10:18 PM Sep 3rd:
Watch Dogs: FIND EVERYTHING YOU CAN ON CASS SUNSTEIN, MARK LLOYD AND CAROL BROWNER. Do not link before burning to disc.
Following the timeline, the reality is that Mr. Olbermann was simply responding to Mr. Beck’s attempt to find dirt on three of President Obama’s czars. As he said, what is good for the goose…
Frankly, I’m tired of this nonsense of manufactured outrage from the right over media personalities. Yes, they do drive the news and “help” in the eyes of some but why not focus our energy and efforts on real issues? Do we really think that the “vast middle ground” or “critical middle” or “independents” or whatever the word of the day is for that group of people that actually decide elections cannot understand the principles of conservatism?
If conservatism offers the best path forward for our country, as I believe it does, why can’t we simply stand on principle and tell our friends and neighbors about it?
A 99 year old gentleman came into the hospital in respiratory distress from a local nursing home where he resided for many years. He was not alert or awake. His family rarely visited. The patient got to the point that to avoid imminent death, he required a ventilator to help him breath, though it was clear to everyone he was near the end of life. The physician and the family insisted on “doing everything possible” to keep him alive and avoid death. The physician had his own reasons. You see, he visited the patient every day in ICU and billed Medicare (I don’t say this about all physicians but there are many out there that care nothing about protocols or best practice or outcomes; only about the billing). The family had their reasons, which appeared to be the check that they were collecting and using for their benefit. Meanwhile the patient, who could not voice his opinion or desires, suffered under our hands.
Instead of providing him with comfort care (the most appropriate care given this situation), we took care of him for 30 days in ICU while we poked and prodded. We tied his hands down so he would not pull out any of the tubes. We turned him and cleaned him, all the while no one visited and we received our orders from the family via the phone. Finally, the decision had to be made to either perform a tracheotomy or take him off the ventilator. The decision was made by his family and physician to perform the tracheotomy. It was done. We finally transferred him to a long term acute care hospital where he died about a week later.
He never received the care he should have received which was patches to decrease his secretions, pain medicine to ease his respiratory distress, music to sooth his soul and the support of a team that knows how to care for the dying. He should have had hospice care.
We in the health care field can be very good at providing lots of high tech interventions to patients who are clearly dying but why? I often say when patients are receiving care that is futile…. “We are not extending life…We are extending dying.”
At this point, many will say “it is not for us to decide and play God, we need to let God work.” To that point, I say to every patient/family that I have ever had an end of life conversations with, “Life and Death is not in our hands”. To stop futile care (removing a ventilator) does not mean a patient will die. Many times they don’t. But by determining the best care, we provide better care for the patient. If you have ever been on a ventilator, you will know what I am talking about.
It is amazing how everyone evokes God’s name to insist that every technological advancement in health care should be used. When protocols and standards show it won’t help, why can’t people let go of control of trying to heal patients without God. Where is your faith? God is the master healer. He does not need healthcare to heal, although he has used it many times. But when it is futile, why not turn to the only one that holds hope in His hand? Withdraw the futile care and let God decide who lives or dies.
My first post is about whether or not health care is a right. I think we can all agree that no one wants to see people go without health care when they need it most but this brings us to my second thought. Is ALL health care a right? As everyone freaks out about the end of life discussions in the current health care bill (HR 3200), I have long thought futile care should not be a right and today I have a better understanding of why I think that and it is not about money.
I attended a CEU seminar today at the Methodist Hospital by Dr. Baruch A. Brody, Ph.D. (pictured above), the Director of the Center for Ethics at Baylor College of Medicine. According to Dr. Brody, discussions surrounding medical futility really started when hospitals and physicians wanted to continue care in opposition to the family wishes. Some of these early end of life cases were Quinlan and Cruzan. Now, it is the reverse. I see so many families insisting on having everything done no matter what the outcome or cost (even if they are uninsured). I had always thought I objected to the waste of money and limited resources. But after hearing Dr. Brody speak, I realize that what I was most incensed about was the abuse of my “professional integrity”.
When I say “professional integrity”, I mean that we, as health care professionals, are there to help, not hurt. So many times I see family members hurting patients rather than helping them by insisting that they receive treatments which are futile, for any number of reasons. What we sometimes do to patients who can no longer make their own decisions at the insistence of the family, is plain WRONG!
I will leave you with this question, “Are patients/families entitled to force the Physician/Institution to provide treatment they don’t agree with and is futile?”. But be prepared because if you answer this question No, you must be prepared to defend the hospital/physician when the family runs to the media and courts to get their way.
Part 1:
Part 2: