Map of life expectancy at birth from Global Education Project.

Wednesday, December 08, 2010

Anecdotal evidence

I can't answer Daniel's question about what percentage of medical spending in the U.S. is for stuff that we just shouldn't do in the first place, but this story in Health Affairs illustrates the problem. A 90 year old man with dementia, heart disease, and diabetes, goes through hospitalization, surgery, multiple tests that cause serious complications, in and out of a rehabilitation facility, all of it costing more than $200,000, and none of it doing him a damn bit of good. He dies six weeks later.

There isn't any corruption, and not even any significant misaligned financial incentives behind this debacle. It's largely a function of our medical culture -- shared by physicians and the public, in this case as represented by the patient's daughter -- which just assumes that doing more is better and leaving well enough alone is irresponsible. And oh yeah, that we must never just accept death.

Listen up buster. Death is unconquerable, at least as of 2010. So is getting older. Get used to it.


kathy a. said...

i might have told this story before. a doctor friend was completely beside himself because his elderly father -- late 80's, in a distant state, with dementia and other stuff -- had some cardiac problems, and his dad's doctor said, "we need to do surgery." and my friend's response was something like this:

Look, I'm a psychiatrist, so cardiology is not my specialty. But I went to medical school, too. My dad is an old guy, and he's got XYZ going on. So IF he survives the surgery, he will be in pain, he risks infection and complications, and he will not understand what is going on. All of that will decrease his quality of life.

So my question is: What is the medical BENEFIT to the PATIENT in doing this surgery?

Cervantes said...

So did the cardiologist have an answer?

kathy a. said...

if i recall, the cardiologist sputtered on in an officious manner about my friend's father's chances for survival without the surgery, and my friend made clear that his dad's chances of survival with the surgery were no better, quite possibly worse, and furthermore, they were not going there because of the quality of life issues.