Posted 3/14/12 on Common Sense Family Doctor
In a moving piece recently published in the Annals of Internal Medicine, surgeon Mark Vierra describes his emergency room encounter with a man dying from colorectal cancer. Called to discuss possible surgery for a perforated bowel, Dr. Vierra sadly observes that despite the patient’s grim prognosis, he and his wife “had not discussed limits on his care, how far to carry things, what to do when the treatment stopped working, or when the end was in sight.” They had not had any of these discussions with their primary care physician or either of his oncologists. After Dr. Vierra reviews the options and the patient’s wife chooses hospice care, he reflects on the wide gulf between the reality of end-of-life decision-making and the damaging political rhetoric of “death panels”:
I should not have been called to see this patient. Decisions like the one we had to make that day should have been made among friends and family or in the company of his family physician or oncologist, at a time when he was awake and at his best, when he was not in pain, and he could remember who he was and he could explain to those he would leave behind how he wanted to be remembered. To have to make such decisions the way we did that day—counseled by a stranger in the sterile alcove of a busy emergency room—is not what any of us would want. That it turned out the way it did, I believe, was fortunate. It would have been so easy for the powerful momentum of modern medicine to have carried his broken body into the operating room and from there to the ICU, where he would be nurtured by the finest medical technology and the clinical compassion of strangers.
Continue reading “The Reality Behind the “Death Panel” Rhetoric”
Posted 12/08/11 on Common Sense Family Doctor
In February, I predicted that Don Berwick would not survive the partisan politics surrounding his recess appointment as administrator of CMS (Centers for Medicare and Medicaid Services), and regrettably, Dr. Berwick indeed stepped down from that position last week despite a number of notable accomplishments in his too-short tenure. Speaking yesterday at the annual national forum of the Institute for Healthcare Improvement, which he led for nearly two decades, Dr. Berwick struck back fiercely at politicians who have used the myth of “death panels” to oppose health reform efforts, and others who he called the “true rationers” of health care. In his own words:
Cynicism grips Washington. It grips Washington far too much, far too much for a place that could instead remind us continually of the grandeur of democracy. … Cynicism diverts energy from the great moral test. It toys with deception, and deception destroys. Let me give you an example: the outrageous rhetoric about “death panels” – the claim, nonsense, fabricated out of nothing but fear and lies, that some plot is afoot to, literally, kill patients under the guise of end-of-life care. That is hogwash. It is purveyed by cynics; it employs deception; and it destroys hope. It is beyond cruelty to have subjected our elders, especially, to groundless fear in the pure service of political agendas.
Continue reading “Striking Back at Care’s True Rationers”
In a “reversal of an earlier reversal,” the Obama administration recently “pulled the plug” on its regulatory efforts to reimburse physicians for providing patients with counseling and advanced care planning information. This concept was jettisoned during ACA’s debate and ultimate passage. We all recall the “death panel” controversy and the ensuing debate that ultimately cost this reform provision its life.
Those of us who care for patients at the end of life cringed when the death panel image was resurrected. End-of-life care discussions can provoke emotion, fear and outright dread. Despite greater acceptance of hospice and palliative care in recent years, underlying attitudes and expectations have not changed much. The outcry in response to the news of the regulatory change reflected the distaste and discomfort with the mere mention of terminal illness, treatment and care options.
Continue reading “Pulling the Plug? Not So!”