Misaligned incentives (especially financial)certai...

2009-06-08T09:12:39.032-05:00

Misaligned incentives (especially financial)certainly are one cause of this phenomenon; I wonder how much of it is also related to training, and how much to the individual variables. Too many of us still have the idea that "we know best", and unfortunately, too many patients still will follow whatever course their physician recommends, because after all, we should know best. At least where I work, we know which specialists will do aggressive therapy up to and including the moment of death, without discussion of patient goals. Our systems have not been willing or able to address them specifically because most often, these are the "productive" docs, who generate income for the institutions. One of these was so bad in our system, it went to Ethics and as a result, our Supportive Care initiatives have gotten some much needed attention/resourcing.

What I would REALLY like to know about this study is why the Australian experience, while not great, is so much better than the American experience? Do we train our docs to ignore patient goals, with the mantra of "life at all costs" so much more than they do down under? Or do we have more overdeveloped egos that make us not attend to the patients' needs? Or do we still view death and dying as optional in our culture? Personally, I see evidence of all of these in various situations.

I'd love to know how others think we can work to improve this situation for the purpose of better care of our patients. Any suggestions that we can try?

Comments on Pallimed: A Hospice & Palliative Medicine Blog: Chemotherapy at the end of life

Misaligned incentives (especially financial)certai...