Thursday, December 17, 2009

Thanatophobia - Ending End of Life Fears in Health Care Reform

The New England Journal of Medicine published an opinion piece by an oncologist who compares his experiences of difficult conversations with patients and families about death to the difficulties and avoidance at a national level regarding the role of advance care planning in health care reform.  Same barriers on a personal as well as national level.

(Thankfully the article is made available as a free pdf so you can easily check out the full article yourself.)

One of my favorite sentences from the piece:

My concern is for the vulnerable patients, but my goal is to reach a level of maturity that enables these conversations to transpire in a manner that is indeed thoughtful.
At the end of the piece he calls for "conversations led by a team consisting of patient advocates (e.g. chaplains) and medical experts espousing countervailing views regarding the use of resources at life's end..."  Yet in the whole article the word palliative is not mentioned once.  Even in the last paragraphs, questions for the future are brought up, but oddly lacking is a question regarding the appropriate role for palliative care teams to help serve this balancing role as they are doing so well in many hospitals across the country. 

Corn rightfully acknowledges the expenses associated with caring for patients in the last few months of life should be a major discussion point in health care reform, but also neglects the common fallacy in those cost-benefit studies which is the lack of effective and easily integrated prognostication tools.

Overall it is a good piece and one you may want to consider bringing to your team for further discussion.  Would this piece be written differently if it was a palliative care clinician?

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