Sunday, August 23, 2009
Public Debate Over Reform Spilling into Family Meetings?
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Have any of you had the discussions with patients or families that referenced/connected your work to 'death panels' or other 'government intrusion' type comments? If so please leave them in the comments.
I have had not heard many, but the one I recall was an out-of town relative who was having trouble accepting the patient's progressive illness in general who asked if the palliative care team was part of 'big brother watching' because 'it is all about money.' The other family members were able to redirect and make a cogent argument about quality not necessarily equaling money spent if the goals were not right.
Some physician peers have commented they hope we (palliative care and hospice) don't get too beat up over this. But I have not had any other staff
What have you heard? Or not heard? Form patients, families, other medical staff?
Do you feel the AAHPM, NHPCO, and other organizations are doing the right things with this recent controversy? What else should we do as a community?
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10 Responses to “Public Debate Over Reform Spilling into Family Meetings?”
August 24, 2009
I haven't had to address this in my hospice work yet, but I've heard a lot of comments in my primary care clinic. I practice in rural Texas, and frequently hear outright racist and ignorant comments from patients about the president and "government." I've heard lots of comments from elderly patients about the evils of "socialized medicine" and the dangers of government involvement, which is where I point out that they are on Medicare and were it not for the government they would have no access to care. Several patients have made comments about my having to give them a pill to get rid of them if they get too old or sick. Usually, I just shake my head and tell them that's completely ridculous and untrue. At times, I've had to bite my tongue, lest I say something unprofessional. For my patients, though, misinformation has become indisputable fact, and they are genuinely (though mistakenly) scared. And they are not reading the New York Times, just listening to Fox News and talk radio.
August 24, 2009
I have not yet heard anything from my patients or their families; but I have read (on facebook)interesting debates amongst my healthy 40 something non-health care worker, friends, regarding fear of rationing and "death panels". I referred them to the Palliative Care doctors Web site, put out by the AAHPM. No one replied....Hmmm
August 24, 2009
The suspicion from patients and families that palliative care was put into place by hospital bean counters has been there long before any of the latest healthcare reform efforts under Obama. I believe this has persisted because we are seen often as "limiting" care, and therefore the logic goes, this must have some kind of financial motivation on the part of the institution. In particular I have experienced these fears among minority groups, who disproportionately have insisted on "life-prolonging", futile care.
August 25, 2009
Misconceptions have abounded well before the latest efforts to refrom the health care system. How else to explain the persistent and continuing reticence of physicans to refer to, and patients to accept, hospice servcies, in most US communities. What's different today is that the skeptics of hospice and palliative medicine are more vitriolic than their predecessors, and their talking points (arguments) are more vivid - "death panels, socialized medicine".
I served as the chief executive of a hospice of a highly-regarded academic health center in the 90s, and the reasons offered for the low referral rate to hospice were abundant (none of the hospitals that were part of the health system had organized palliative care programs at that time) - patients were referred to academic health centers because they wanted to avail themselves of the most sophisticated medical care for cure; the attending physicians were already providing palliative care; the patients' religious/cultural beliefs made them unready for palliative care, etc. We've all heard them before, and we still hear these reasons now.
It's just that now, in the context of health reform, palliative care is called 'rationing."
And it gains credence because there is so much money in late-life care. Think otherwise? take a look at a 2006 Health Affairs article titled "End-Of-Life Care At Academic Medical Centers: Implications For Future Workforce Requirements. "
August 25, 2009
Our hospice and palliative care intake department has actually had an increase in informational calls from family members calling to discuss their loved one's declining condition and inquiring if hospice would be appropriate now, or how to initiate it when the time comes. Many of them have advanced directives in place, but the subject had not yet been brought up by the attending physician. One referral came from a PCP for a hospice evaluation based on a call from the patient's wife, letting him know that her husband did not want aggresive treatment or hospitalizations. When the intake RN contacted the wife, she explained her husband did not want services yet (nor was he appropriate), but she just wanted to make sure the PCP was aware of her husbands wishes!
August 27, 2009
The Huffington Post has a great video that puts all of the hysteria in perspective...good for a chuckle...enjoy.
http://www.huffingtonpost.com/2009/08/26/your-friendly-neighborhoo_n_269388.html
August 27, 2009
I am not sure if the fears being expressed by millions of Americans are unfounded or not. I 100% believe in palliative care and hospice when appropriate. I believe the hospice and palliative care physician's intentions are not malicious or insincere. However, I do not believe that from my government and therefore disagree with their involvement with ACP as well as universal health coverage. My questions for MDs are: Why would we support this new reform as a whole when the other programs put in place by the government have failed and are now or at least soon to be completely bankrupt (i.e. social security and Medicare)? Why take on the whole population when we can't take care of a fraction of it? And, is it really so silly to be scared your health care will decrease or be rationed when one of the proposals of this reform to pay for it is by cutting Medicare costs further? Aren't there better ways to ensure good care without such an outrageous reform? I understand this blog is concerned primarly with the ACP aspect, but I think these questions need addressed before people will ever be "comfortable" with what is happening in Washington. Also, as I am an RN, not MD, I am curious how you feel about having the government dictate to you even more so in your practice and having control of your reimbursement. Medicare already reimburses MDs very poorly. Why would you support more government involvement in your profession, where many enjoy the autonomy?
August 28, 2009
Thanks for all the comments everyone.
Anon 8/27, You ask a lot of important political questions about health reform in general, but working with Medicare mainly with hospice I have been pretty pleased. The commercial insurance companies have been very helpful too, especially with working with patients in our inpatient facility.
As far as reimbursement the government already sets a lot of payment rates with medicare and insurance companies often follow suit with adjustments here and there above and below.
I think more uniformity of care practice would be a good thing for medicine. there are so many people in health care reinventing the wheel, and the wedge and the lever and then reinventing the wheel again. Some standardization would probably be helpful.
August 30, 2009
I had a daughter of an End Stage Parkinson's patient say, "If it were up to Obama, he would give a pill to my mom to end it all." I was stunned for a moment and took the next 10 to 15 minutes to educate her on the bill and its purpose and how it doesn't consist of "death panels" and it's not there to "get rid of old people." Wow!!!
September 01, 2009
I haven't heard anything from patients/families.
Have heard a lot of talk about Ted Kennedy.
Amongst clinicians (both palliative and otherwise) - lots of gallows humor about 'death panels' has been heard (and made by me).
I know some patients/the public are worried for a variety of reasons but I have to believe history is on 'our side': people (our patients, our neighbors, our families) don't want to be flogged to death, spend 6 out of their last 8 weeks of life in hospitals, etc. etc. The HPM (and allied) community offer patients what they want.
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