Friday, May 01, 2009

End of life care on WBUR

Here are all five segments of Rachel Gotbaum's important series on end of life care issues broadcast this week on WBUR. The series is entitled "Quality of Death: End of Life Care in America." There will also be a full Inside Out documentary with the same name that will air Sunday, May 3 at 8pm and Thursday, May 7 at 9pm.

First segment: "A costly ordeal."

Second segment: "What the patients want."

Third segment: "Palliative care."

Fourth segment: "Talking about death."

Fifth segment: "Comfort and costs."


e-Patient Dave said...

Thank you so much for posting these. I've been "meaning to get around to" hunting these down.

In my depths, two years ago, I got to think about what the last days would be like. Everyone will get there; best to be awake about it now.

Anonymous said...

Paul: Glad to see your enthusiasm for WBUR's excellent programming. As a BIDMC employee, rabid listener and frequent volunteer at the station, I hope to take your pledge call one day - or even see you stroll into the volunteer room to take calls & pledges with me. Thanks for promoting my favorite NPR radio station.


Anonymous said...

My pledge is on automatic renewal!

David Szabo said...

When my father was dying from end stage renal disease, he made an informed decision to decline all kinds of interventions, including dialysis (he as a retired internist--he knew exactly what he was doing). Eventually, he enrolled in the hospice option under Medicare.

One day his condition deteriorated, and some of my mother's friends convinced her to call an ambulance to take Dad to the emergency room. Once at the hospital, he was hooked up to a dialysis machine--exactly what he did not want. When he tried to get up from the gurney, he was put in restraints. He fell into a coma.

The next morning I got a phone call from a nephrologist. His "care plan" was to put my comatose father into a long term care hospital and dialyze him (probably in restrains, of course) for an indefinite period of time.

I was flabbergasted. Fortunately, my Dad's primary care physician intervened, and my Dad was place in an inpatient hospice program, where he received compassionate care that complied with his own prefernece and directives. He died peacefully.

As the radio story pointed out, most people want to die at home, near their family members, at peace, and in comfort. The average American dies in a hospital, in pain, and surrounded by strangers. The extraordinary cost of futile end of life "care" has been well documented.

Why is it so hard to get patients into home or facility based hospice care?

What are we going to do about this? said...

Rachel : Superb work here.
While it sounds academically coherent that the PCP has a talk, never forget,that a simple form like a CCDNR - Comfort Care Only- Do Not Resuscitate created huge stress to me as a proxy as 1./It was ignored- with Dad's necklace bagged as a jewelry item and not noted at pre surgery prep in '03 and 2./ When Dad returned to short term nursing home placement to die, I told the Ambulance Supervisor how healthy a life Dad had lived ,despite being coded AMA 3 years ago, then at age 93, with a CCDNR ignored. She responded:" No such form accompanied him on this short run tonight!" Dad had come from BIDMC- Paul's facility. Both times, I reported each facility to Mass DPH. Whose dern form is it - the facility's or Dad's ? It appears each place wants their own forms done and it doesn't travel with the patient. After Dad peacefully died, I called Patient Relations to be sure they got my complaint . The staffer kept the focus on my alleged process of " grieving. " It was like kick the can.I seek an answer before 2014 electronic records goals may come. Even that would not be accessed by Ambulance,though. Fix this. Joe