Thursday, August 7, 2008
The Happy Hospitalist contributed a 'Reader's Take' ("All for One, and None for All") to the blog Kevin, MD about the frustrations with out of control health care spending withing Medicare. Here is the strongest argument from the piece:
We will have to say no. No to dialysis. No to life support. No to elective procedures. No to brand name drugs. No to the latest expensive technology. We will have to place greater weight on quality of life over quantity of life. We will have to demand hospice care in futile situations. We will have to demand palliative comfort over slice and dice. We will have to reject marginally effective proceduralization and imaging of our elderly. We have to. We don’t have a choice. There is no other way.Palliative care is supported and accepted by the public in part because there is still choice and some semblance of free will in the our current health care system. What concerns me is how will palliative care be viewed when it is not a choice? I do not think our field would have such an easy time gaining the public trust if hospice/palliative care services were demanded or by any means 'forced upon' anyone. We already have enough of an uphill battle in addressing tough decisions many do not want to face before we go throwing money and limiting choice into the equation.
Maggie Mahar replies in the comments section (Comment #2) (and on her own blog) with an enthusiastic endorsement of widely available palliative care services summed up here:
But the palliative care team is not there to save money. It's there to try to make that the patient gets appropriate care.Interestingly the comments start even addressing how palliative care teams are structured. (Specifically +/- psychologist)
What will palliative care look like in a medical system that may have to say 'No' more often?