tag:blogger.com,1999:blog-32053362.post7637077541056550451..comments2024-03-26T00:25:34.026-04:00Comments on Not Running a Hospital: How to achieve compassionate end-of-life-carePaul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger9125tag:blogger.com,1999:blog-32053362.post-69086161847031389422011-03-16T14:10:59.213-04:002011-03-16T14:10:59.213-04:00Returning to my soapbox on implementation, here is...Returning to my soapbox on implementation, here is an example of how good intentions can become subverted in implementation: (partial quote only)<br /><br />Abstract<br />BACKGROUND: Patients and families commonly discuss end-of-life decisions with clinicians to create a treatment plan based on patient wishes. In some instances, respect for patient autonomy in making choices may create the potential for patient harm. Medical treatments are often performed in groupings in order to work effectively. When such combinations are separated as a result of patient or surrogate choices, critical elements of life- saving care may be omitted, and the patient may receive nonbeneficial or harmful treatment. A partial do-not-resuscitate order may serve as an example. <br /><br />http://www.ncbi.nlm.nih.gov/pubmed/21057317 <br /><br /><br />(Example: do not intubate)<br /><br />nonlocalAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-26184549495474536292011-03-16T07:54:40.253-04:002011-03-16T07:54:40.253-04:00Barry, I think your comment about where the Polst ...Barry, I think your comment about where the Polst is stored is critical. One of my professional interests has always been how we implement, on the front lines in health care facilities, all the fancy ideas of administrators and medical executive committees which sound so good on paper. Emergent access to such a document is key and explains why a large percentage of DNR orders are never carried out either, for instance. Or, if there is family resistance, the medical personnel just give up. With the Polst as a direct medical order, conceivably there could be consequences for NOT implementing it, changing the default position.<br /><br />In general, when confronted with a new idea however, it is always useful to ask - how would this be implemented in real life? (The tax code comes to mind.) The answers are not so easy.<br /><br />nonlocalAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-38534219083124008792011-03-16T05:13:28.194-04:002011-03-16T05:13:28.194-04:00The Polst or Molst is a wonderful idea. The fact ...The Polst or Molst is a wonderful idea. The fact that it is also signed by a doctor as well as the patient gives it more credibility both within the medical establishment and with family members. Hopefully, it is also stored on a registry where it is available to providers anywhere. Everything I read suggests that only about 25%-30% of people have executed even a living will or advance medical directive. When the end of life approaches many patients can no longer communicate at all or, if they can, they may not be mentally competent. Meanwhile, middle age adult children who don’t know what their parent wants and doesn’t want tells doctors to “do everything,” in part, because they haven’t yet come to grips with their own mortality and can’t or won’t let go. It can all be avoided so easily by executing these documents. The patient gets wanted care and doesn’t get unwanted care and, most likely, the healthcare system saves money.Barry Carolnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-65287423986873586142011-03-15T22:18:50.754-04:002011-03-15T22:18:50.754-04:00Barry;
Well, a couple states have managed it. It&...Barry;<br /><br />Well, a couple states have managed it. It's like a lot of things - until we start discussing it, the possibility is not even on the table.<br /><br />My brother with Parkinson's disease, for instance, would like to have this option available without putting his doctor or his loved ones at legal risk.<br /><br />nonlocalAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-10576832236151164962011-03-15T22:05:07.119-04:002011-03-15T22:05:07.119-04:00Here's another take on the subject from the WS...Here's another take on the subject from the WSJ. The 'Polst" document is an official medical order and thus readily available and enforceable, unlike an Advance Directive:<br /><br />'Regardless of whether people fill out Polst forms or advance directives, or both, a coalition of health-care groups says it is important for people to make some decisions about end of life wishes and to choose a surrogate who understands their wishes to step in if necessary. The group is promoting April 16 as National HealthCare Decisions Day via its website, NHDD.org. "There is so much fear about having these discussions, when for most people the problems are going to happen when they haven't had these discussions," says Amy Berman, a senior program officer for the John A. Hartford Foundation, which focuses on improving health care for older Americans.'<br /><br />http://online.wsj.com/article/SB10001424052748703327404576194942197661606.html?mod=WSJ_hpp_sections_health<br /><br />nonlocalAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-78370506297656501172011-03-15T20:25:08.825-04:002011-03-15T20:25:08.825-04:00nonlocal –
I think assisted suicide legislation w...nonlocal –<br /><br />I think assisted suicide legislation would be a mighty tough sell in most states. I, for one, would be uncomfortable with it.Barry Carolnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-83496786937882093792011-03-15T16:38:54.109-04:002011-03-15T16:38:54.109-04:00This is certainly a more mindful discussion than t...This is certainly a more mindful discussion than the 'death panels' scare tactics. However, let me be a bit provocative - what about an assisted suicide law?<br />I don't live in MA so obviously I am not picking on this state, but I do believe it is something that mindful people should consider - for others who might want the right, if not themselves.<br /><br />nonlocalAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-69314834549335287922011-03-15T13:36:20.463-04:002011-03-15T13:36:20.463-04:00Congratulations to the MA Expert Panel on End of L...Congratulations to the MA Expert Panel on End of Life care. It looks like we’re making some meaningful progress on this important issue. While I agree that the overall effort should be patient centered to ensure that they get the care they want toward the end of life and don’t get care that they don’t want, the likely happy byproduct of a successful effort here is that it will save money for the healthcare system as well. While, in the end, some hospitals, doctors and drug companies might lose some revenue, it’s good for patients and it’s good for the society and the economy.Barry Carolnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-21557260646462958332011-03-15T04:58:09.114-04:002011-03-15T04:58:09.114-04:00So important -- but it's especially important ...So important -- but it's especially important to inform siblings and children of your wishes. They are a powerful source of ordering everyone to conduct exactly the tests and treatments you want to avoid. God love them, they mean well.nasovnoreply@blogger.com