On Demand
Do The Right Thing
Friday, June 20, 2008
Dennis McCullough, M.D., author of My Mother, Your Mother: Embracing "Slow Medicine," the Compassionate Approach to Caring for Your Aging Loved Ones, talks about how to avoid "death by intensive care" and other end-of-life issues.
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Hospice, dreaded hospice.
Seeing someone you are close to die in your arms in hospice will change you forever.
This is a personal issue and there is no cookie cutter, I think though most people would prefer to die quietly at home with their loved ones.
this might sound heartless but the united states has the one of the lowest infant mortality rates of the industrial world (even lower than cuba) is it moral to spend billions on dieing boomers so they can live trapped in a bed for 6 more months? that's not how i woould want to die.
sorry if you're offended
They can say slowing down or "not pursuing anymore aggressive treatment." The doctors make the person comfortable with medication to keep them pain free if they want, if lets the person die with dignity.
In our fast society with its microwaves, IM, ipods, cell phones, blazing fast Internet, one night stands, let's not throw the baby out with the bath water and toss out our elderly population. They need respect and care, if we are nasty to our parents, our children will just toss us off a bridge when we are old and sick.
I think it's important with older parents to pay attention to their needs, listen carefully to what they want to do with their medical care and needs, and be their advocate vis a vis doctors, hospital personal, etc.
Katie
they won't have to toss me. i 'll jump if im that bad off. why waste the money and cause more pain for them.
can you just ask your parents "how will you want us to take care of you twenty, forty years from now when you might not be able to answer that question" ?
Hjs, unfortunately as my now dead aunt reminded me that you may not be able to get to a place or the bridge that you might jump off of, because you may not be able to get out the bed. It is tough for the caretakers and the patient, but unfortunately nature controls the process.
i think people don't know how much end of life care you can receive at home through a geriatric home care program offered by several medical centers in nyc. it is also important to work with a geriatrician who is trained to have these conversations about goals and preferences, health care proxy, community dnr, etc. with patients and caregivers. it's about taking baby steps. many people unfortunately don't have to deal with these issues until their loved one has landed in the hospital.
Relatives and care-givers have to stand guard against what I call the Geronto-Industrial complex. As long as an elderly patient is alive-- the hospital can BILL for EVERY service, EVERY Pill, EVERY procedure. And sometimes that's the cause of the non-stop cascade of in-hospital procedures and medications in reaction to the side-effects of previous meds.
after all. . . the cold truth is, an elderly patient is near death-- and when the patient dies, Medical Care PAYMENTS stop. And a dead elderly patient rarely is the source of malpractice suits.
Hospital Near-Death care is a Money Making Business.
hjs,
I think you mean the US has one of the HIGHEST infant mortality rates in the industrial world.
There is so much money wasted on unnecessary care both for older people and people with enough health insurance to cover it, while others go without. It drives up costs for everyone. The health care problem in this country will never be solved unless we have a serious conversation about how much health care is appropriate and how much it should cost.
Sounds like the medical industry is largely driven by the pharmaceutical industrial complex. I heard an excellent and enlightening segment on NPR about the "twenty-somethings" that are marginally educated in medicine but very well versed in sales techniques, can't recall where unfortunately (kcrw or kpcc perhaps).
We have a responsibility, right now to make our friends and family know our wishes so that they do not have face these crises on our behalf in which medical intervention seems the only recourse.
Why is it that a profession sophisticated enough to do surgery on a preborn cant't figure out a way to reward itself in a way that more complex than the piecework process used for drill press operators?
If outcomes rather than just procedures were determinants of doctor's compensation, "The Right Thing" would occur more naturally.
As a geriatric nurse practitioner I feel that the people we need to educate are the families. Elderly patients do not need blood work and other tests if no treatment is desired. They have the right to refuse "routine testing". Medications to prevent conditions are not always necessary for someone in their 90's. Lowering cholesterol to prevent a future heart attack may also reduce appetite thus depriving someone of one of the pleasures they can still enjoy. Joan Cornish
hjs,
brian reads your comment but i think you meant we have one of the highest infant mortality rates in the so-called industrialized world; it is hard to listen, type and edit...
Susan
yes i know. i thought of that but i was just being sassy. the point is should we really burden our children?
i'd like to think i'm brave enough to know when it's over and like the old Inuit floating away on a iceberg
HJS,
just a note, the U.S. has one of the highest infant mortality rates of all developed countries. Of course its lower than the majority of the rest of the world, but still high compared to Europe, Canada, Japan
When my father (almost 80) was hospitalized 6 years ago, there were two things I saw: a) medical people frequently talked about the patient with us as though they were part of the furniture without having anything to add to the discussion of his condition; b) later when he was no longer able to participate in the discussions and was in fact dying, his regular doctors did not give us a brutally honest assessment of his condition; it was a weekend subsititute who told us that he was in a state of steady decline; only then could we have a tough, but realistic discussion about his future care.
Thanks for your attention.
Why do physicians use oxycontin for bedsores at Nursing Homes - at least from my parent's experience. We found out after a few weeks.
mc
oops yes my bad. highest.
have you been away?
One reader says
"There is so much money wasted on unnecessary care both for older people and people with enough health insurance to cover it, while others go without. It drives up costs for everyone."
Older people, as well as children, are important to our society, and we cannot throw them away.
You could say as much about smokers, or people with unhealthy habits, as far as taxing our system financially.
When you are older, with a lifetime of family and experiences you have feelings about. Get back to me with how you feel about this, then.
And why push more money for infants? Because you think they're cute, like puppies or kittens? I would ask why do we spend money on trying to resuce premies? Why not let them go? The point: STAY OUT OF OTHER PEOPLE'S DECISIONS!
Sorry, the U.S. does NOT have one of the lowest infant mortality rates - it ranks 180/222.
Estimated 2008 numbers put Singapore as the country with the lowest infant mortality rate.
It's dangerous to assume that everything we do in America is at the cutting edge, often our medical system adheres to practices that are more beneficial to the insurance companies than the patients.
important heads-up to children of aging parents, re: how dehydration symptons of elderly parents in a rehab or nursing home are FREQUENTLY misdiagnosed and dismisseed as disorientatio and dementia, leading to renal failure and death. I'm a social worker doubling as my aging mom's care coordinator. A nightmare experience we had, which was echoed by dozens of people who heard about this, was that when my mom was in a Rehab to recover from a broken hip, she entered as an 83 year old who was still independent and driving and politically active. The loss of appetite she had aftr surgery led to her not eating or drinking enough in rehab, and if it were not for my return from vacation to find her in a state of delirium,approaching renal failure, she would have died, as staff at highly reputable rehab missed this completely. Training must be improved.
They sure aren't serving elders well nor are they serving the rest of us well. The pill's the thing these days, pills for everything and if one gives leaves you with a side effect that's unpleasant you get a pill to counter that and on and on. I think we all know about it now. My mom (86) and aunt (84) tell their drs NO to more pills, take a minimum and are healthier than I am.
chris o
yes and don't forget working and hiding my internet use from my boss. and it's friday
There's a new movement called Functional Medicine which does this for everybody. I know two docs (siblings of mine) - one said of our near nonogrnatian parent, well, she's old... - the other is an MD who practices a range of gentle, alternative medicines - those interventions have pulled our parent through a nasty disease into some happy, lively years to enjoy.
Michael B. Schachter, M.D. and other MDs with a conscience are trying to enact a bill in Albany that will allow MDs to submit medical evidence in state disciplinary hearings. Currently, a doctor can have his license suspended merely because he didn't follow the drug oriented insurance codes. This is one solution for the shoddy care for our eldery. contact:
Michael B. Schachter, M.D., CNS, FACAM
Schachter Center for Complementary Medicine
Suffern, NY 10901
845-368-4700 Office Phone
http://www.mbschachter.com/
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