KEY IDEA: Patients are people. Our healthcare system is not designed for people, it’s designed for conditions. We spend too much money on treatments that may prolong life a few weeks but at what about the quality of life and the patient’s voice?
In the last years of my mother’s life, she told me that she was tired. She was tired of going from doctor to doctor, tired of all the different treatments, tired of all the pills and tired of doctors treating her like just another patient. She decided to forgo any more treatments which would, in turn, lead to her demise. As we started to clean up the house afterward we realized what she was talking about.
The amount of money we spend on terminally ill cancer patients is staggering. Medicare, a couple of years ago, paid $55 billion just for doctor and hospital bills during the last two months of patients’ lives. It has been estimated that 20 to 30 percent of these medical expenses may have had no meaningful impact. Most of the bills are paid for by the federal government with few or no questions asked. This statistic is from a 60 Minutes story on “The Cost of Dying” and is one reason our healthcare system is in trouble.
According to the JAMA Network, “people in the United States spend a lot of money at the end of life. In fact, about one-quarter of all Medicare spending goes toward care for people during their last year of life. Beyond this shockingly high number, we know that end-of-life care patterns and spending vary widely across hospitals and communities. For example, although about 1 in 8 elderly persons living in Utah die in the hospital, the number is nearly 3 times higher for those who live in New York.
25% of Medicare’s annual spending is used by 5% of patients during the last 12 months of their lives.
Why is this happening? Lot’s of reasons..
- Physicians reluctance to have “the discussion” with patients and family.
- Families reluctance to let terminally ill loved ones move to the next stage of life.
- Hospitals trying to make money.
- Healthcare community reluctance to let a terminally patient chose his/her own next steps.
No HCP wants to tell a patient that “they have run out of options”. It’s hard to look at a trusting patient and say “it’s over” but it may be time to rethink this approach.
First, we need to look at death as the next phase of life that we all have to approach. Second, death is welcome to some patients who are suffering immeasurably. An IV morphine drip is no way to live. Finally, if we believe in our Lord than we have to be strong and believe that when our loved ones pass they will ultimately be at peace. We grieve for the living not for those at peace.
Our healthcare system is designed to treat conditions, not people and families. Science yes but also with a healthy dose of compassion.