Map of life expectancy at birth from Global Education Project.

Wednesday, April 07, 2010

This still makes my blood boil . . .

Paul Kettl, M.D. (yeah, he should get a vowel) writes an important essay in JAMA, unfortunately behind the subscription wall. He's for the Death Panels, or rather what was labeled Death Panels by depraved Republican liars -- the proposal that Medicare pay for end-of-life counseling if people want it. Dr. Kettl is a geriatric psychiatrist who used to work in an inpatient unit where most of the patients had dementia. He writes:

As part of the care . . . we would meet with the patient and then with the family to explain the type of dementia, the typical course that could be expected. . . . Finally, we talked about what the future would bring, usually giving the already-burdened patient and family an explanation of the inexorable downhill course of progressive dementia leading to death. We . . . asked the patient and the family about what care they may want both now and in the days ahead.

... [F]amilies typically said two things to us. First they thanked us for taking the time to share some education and discuss these issues. . . . [T]he second thing the families always told us: "No one has ever sat down with us to tell us what was going on, what we could do."

Dr. Kettl goes own to explain that primary care physicians, with only a few minutes available for each visit, just don't have time to do this. Medicare doesn't pay for it. As you will recall, it was proposed as part of the health care reform legislation, but howling mobs of enraged citizens hurled so much abuse at members of Congress over the proposal that they took it out.

Physicians should ask [patients' wishes], and it is reasonable to submit a bill for this meeting. . . . Patients should expect that care will be available for their illness . . . but they should not have procedures forced upon them out of ignorance of which medical procedures they may have chosen. That's why I'm in favor of 'death panels.' But it won't be in this or any bill in the near future. The proposal was sunk by a phrase. . . .

This was among the most shameful moments in our recent politics, and it has plenty of competition. Sarah Palin has the morals of a tapeworm.


kathy a. said...

this sounds like a very interesting essay. naturally, i agree fully.

i imagine that some of this kind of counseling can be covered to some extent under other rubrics. it is certainly an important part of hospice care, when/if a patient gets there. but before that point, the default tends to be maximum medical intervention, and real discussions of what the patient faces and what choices are available depends quite a lot on the willingness of particular doctors to have those discussions, and the insistence of families/patients as well.

Cervantes said...

People really should have these conversations with their PCP, if they're lucky enough to have one, who knows them, with whom they have a relationship.