Sunday, December 28, 2008

Why Emergency Medicine Can Add to Health Care Costs....

In America, everyone expects perfection...people want to live forever (or as long as they possibly can). Hence my candid feelings about prolonging the inevitable. Frequently, patients are transferred from Nursing Homes sick...very sick. They arrive with limited information (hopefully a copy of the medical list and a short one page synopsis of their medical history). Unfortunately, many cannot speak secondary to their condition.

Many times treatment decision need to be made rather swiftly, sometimes in seconds, sometimes in minutes and more frequently in an hour or two. The decisions will ultimately add to the costs of medical care and perhaps to their suffering or perceived discomfort. What is frustrating to providers in the ED, is the lack of communication for advanced directives, documents that would help health care professionals determine "how far, and at what costs" patients and next of kin want for care.

All too often in these extreme cases, the patient is too sick or comatose to make such a decision and family members are guilt ridden with making a decision that may ultimately lead to a loved one's death. Unfortunately, families do not always make decisions in the best interest of the patient but rather for the best interest of the psychiatric care of the family - like placing octogenarians on ventilators when there is absolutely no hope of recovery let alone a decent quality of life.

In America, we spend a considerable amount of money near the end of people's life's but, even with health care reform, I can't see the government changing this. Do you really expect Presdient Obama and the rest of Congress to say, "Grandma's lived long enough, time to pull the plug?..." NOT!

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