tag:blogger.com,1999:blog-32053362.post1899017967111753387..comments2024-03-29T06:37:18.029-04:00Comments on Not Running a Hospital: Occupy With GracePaul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-32053362.post-49434365077376646102011-11-27T15:26:24.536-05:002011-11-27T15:26:24.536-05:00Dear Anon 8:49:
Thank you for the abstract; I rea...Dear Anon 8:49:<br /><br />Thank you for the abstract; I read it. (I am retired and therefore have no access to the full text). Interestingly, the abstract describes my mother's later conversation with her PCP, but the hospitalist in the ER seemed only interested in a yes or no answer so she could check off the proper box in the chart. This approach, of course, is no good for either the patient or the hospital, nor the taxpayers. Too bad some of us MD's are still so shortsighted......<br /><br />nonlocal MDAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-5304684768022866152011-11-26T08:49:14.787-05:002011-11-26T08:49:14.787-05:00@nonlocal MD
http://www.annals.org/content/151/5/3...@nonlocal MD<br />http://www.annals.org/content/151/5/345.abstract<br />An excellent article in the Annals of Internal Medicine about addressing these thorny issues.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-6223692798272673442011-11-24T14:38:51.083-05:002011-11-24T14:38:51.083-05:00At the St. Joseph's Healthcare System, we open...At the St. Joseph's Healthcare System, we opened New Jersey's first geriatric ER nearly three years ago. It was an immediate success and includes a significant palliative care component where end of life discussions are initiated. Not "death panels," but compassionate care.Johnnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-34676230451308126222011-11-24T12:28:03.504-05:002011-11-24T12:28:03.504-05:00Drane and others who are working hard to stimulate...Drane and others who are working hard to stimulate these conversations spearhead what should become a centerpiece of medical engagement. Families have little direct knowledge from which to weigh risks and benefits, and few physicians have training to standardize and humanize the process of decision-making.<br /><br />Conflicts at the intersection between the strongest desires for survival and relief from suffering has been demanding daily work of hospital ethical support services and social work for decades, but elevation and resourcing from the medical community is variable, and often poor. 'Engaging with grace' could well be their job description. Hospitals would do well to follow Drane's lead and require standardized training to all providers in appropriate information sharing and ethics-driven support of the iterative process for patients and their families. CMS should invest in these services as core prevention against the wasteful, and harm prone, high variation care most likely to occur at the end of life. We need to push for support along the entire chain of such decisions: demographics and technology alone predict a tsunami ahead.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-58995226204008540432011-11-23T10:13:15.856-05:002011-11-23T10:13:15.856-05:00These conversations are imperative, but in my own ...These conversations are imperative, but in my own family I recently found they are not simple. Despite the presence of a fairly explicit living will document forbidding resuscitation which I was holding in my hand, my 89 year old mother, on admission from the ER for a GI bleed, was asked if she wanted to be resuscitated if her heart stopped. Her reply: 'I'd like you to at least try.'<br /><br />On a visit with her primary doctor after discharge, he asked the same question but with all the dismal statistics about her chances of surviving resuscitation with normal cognition, of leaving the hospital, etc.<br />Her answer that time was different.<br /><br />Although I still have the written document, I now realize my brother and I will still largely be on our own when the time comes. Any direction on how to solve this dilemma is welcome.<br /><br />nonlocal MDAnonymousnoreply@blogger.com