http://www.medrants.com/archives/5085 Internal medicine, American health care, and especially medical education Sat, 11 Feb 2012 15:15:48 +0000 hourly 1 http://wordpress.org/?v=3.3.1 http://www.medrants.com/archives/5085/comment-page-1#comment-530757 Albert Fri, 11 Dec 2009 06:27:40 +0000 http://www.medrants.com/?p=5085#comment-530757 But you're a fan of Thomas Sowell (as am I).  You should know that the only system that work is <a href="http://www.albertfuchs.com/blog/?p=303">rationing by price</a>. But you're a fan of Thomas Sowell (as am I).  You should know that the only system that work is <a href="http://www.albertfuchs.com/blog/?p=303">rationing by price</a>.

]]> http://www.medrants.com/archives/5085/comment-page-1#comment-530750 solo dr Thu, 10 Dec 2009 02:49:44 +0000 http://www.medrants.com/?p=5085#comment-530750 Often it is the children wanting to know how long mom/dad have, which costs more.  I have patietns voice their wishes not to have extreme measures and not to have extreme treatments.  Most elderly patients want to die peacefully and comfortable, when it is time.  When the family members get involved and no living will exists, CTS, MRIS, ICU admisisons all happen to cost the system millions and to prolong lives that are without quality.  Hospice is underutilized in America but would allow patients to pass away peacefully while saving the system millions. Often it is the children wanting to know how long mom/dad have, which costs more.  I have patietns voice their wishes not to have extreme measures and not to have extreme treatments.  Most elderly patients want to die peacefully and comfortable, when it is time.  When the family members get involved and no living will exists, CTS, MRIS, ICU admisisons all happen to cost the system millions and to prolong lives that are without quality.  Hospice is underutilized in America but would allow patients to pass away peacefully while saving the system millions.

]]> http://www.medrants.com/archives/5085/comment-page-1#comment-530748 Doctor Moxie Wed, 09 Dec 2009 20:35:00 +0000 http://www.medrants.com/?p=5085#comment-530748 I would argue that other factors may have been at play in the 2nd scenario.  As an emergency medicine physician, I see countless patients who are in their last six months of life.  Some are part of hospice care, some have DNR/DNI directives and some have well-informed, thoughtful families.  Many, however, come in by ambulance with no paperwork and no family members and are unable to speak their wishes clearly.  Pages to family doctors go unanswered for hours, leaving me with a very sick patient who I know will likely die shortly, but without the freedom to simply make them comfortable and avoid costly and unnecessary workups.  What could make this better?  So many things--involved families, written directives, communication with emergency staff, an electronic medical record. . . and the list goes on.    I would argue that other factors may have been at play in the 2nd scenario.  As an emergency medicine physician, I see countless patients who are in their last six months of life.  Some are part of hospice care, some have DNR/DNI directives and some have well-informed, thoughtful families.  Many, however, come in by ambulance with no paperwork and no family members and are unable to speak their wishes clearly.  Pages to family doctors go unanswered for hours, leaving me with a very sick patient who I know will likely die shortly, but without the freedom to simply make them comfortable and avoid costly and unnecessary workups.  What could make this better?  So many things–involved families, written directives, communication with emergency staff, an electronic medical record. . . and the list goes on.   

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