Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

We’re already throwing grandma under the bus

Gene Uzawa Dorio, MD
Physician
December 7, 2013
Share
Tweet
Share

“Throw grandma under the bus” clearly conveys anger, sympathy, and fear when health care decisions are made outside the realm of medical professionals. Within the doctor-patient relationship, alignment of physician expertise with an individual’s personal decision should keep insurance company executives, hospital CEOs, and government authorities from interfering.

Are we naive to believe interference isn’t already occurring?

A doctor orders a breast MRI to further evaluate an abnormal mammogram, but the insurance company denies approval. Physical therapy after a broken hip must be done at a facility sixty miles away instead of down the street because “we don’t have a contract with them.” The physician recommended evidence-based cancer surgery cannot be initiated as it is not authorized by the insurance company. A mid-nineties woman is told she must go to a nursing home because her “double” pneumonia is beyond the four days allotted to the hospital for her care. Yes, we’re already throwing grandma under the bus.

The health care role of doctors is to heal, and for some extends to end-of-life care assuring minimal pain and maximum comfort in your final days. Somehow though, unscrupulous profiteers have found ways to covertly intervene claiming patient benefit, when their real purpose is profit. Therefore, I wish to forewarn and expose to caregivers and health care professionals new threats against those we care for.

As an internist and hospice physician, I was asked to see a patient with a “terminal disease” for end-of-life comfort care. She lived with her family on a ranch outside our town, and when I arrived, she was actively sweeping their front porch with no signs of debility or pain. Being able to access her hospital chart, I found the HMO had not done the usual workup nor staging of her cancer. As Medicare funding is separate, by placing her on hospice the HMO was able to financially “wash their hands of the patient” saving money by not providing any further care. I reported them to a state agency, and advised the family of the problem resulting in appropriate care and treatment.

In the hospital setting, I now see aggressive questioning of families and older patients seeking code status change to DNR (do not resuscitate), coercing them to a lower level of care. Coupled with this sometimes is an attempt to place them on hospice. Under certain circumstances I cannot disagree, but wouldn’t you expect those asking these questions be physicians? Unfortunately, they are not. Sometimes they are nurses, social workers, and even case managers maneuvering under the guise of “palliative care team.”

Furthermore, part of this stratagem is oversight of the palliative care team is by an administrative hospital committee which formulates policy away from the scrutiny of physicians. Orders are placed by non-physicians asking for palliative care personnel to consult patients which in not only illegal, but practicing medicine without a license.

Far before hospitalization, I discuss with my elder senior patients their sense of quality of life and expectations of how aggressive they want to be treated at end-of-life. No one lives forever, and everyone uniquely makes decisions based on personal relations, family, religion, experience, common sense and reality.

But hospitals abide by Medicare rules of payment and might lose money when a patient stays too long. Therefore, reducing care by forcing code status changes of patients under duress is inappropriate especially when it is not presented by the physician. A new twist in this problem is at some hospitals, physician care is turned over to a hospitalist, who has never met the patient nor family. If these hospitalists are paid directly or indirectly by the hospital, you already know the tenor of their questioning.

Not to be misunderstood, there are many caring physicians, including hospitalists and palliative care teams, focusing on the best interest of the patient. Again, sadly, who pays them determines the fate of many of our elder seniors.

The present medical system is too vast and complex for most to understand or read between the lines. Being aware of the above unseemly profit-making tactics might help you and your loved one ask questions and make better choices. Personal decisions should not be twisted or coerced by insurance company executives, hospital CEOs, or HMO profiteers, and ultimately we must demand to uphold the sacred relationship between doctor and patient.

Throwing grandma under the bus should not be an option.

Gene Uzawa Dorio is an internal medicine physician.

ADVERTISEMENT

Prev

It's a fearful time for medical students

December 7, 2013 Kevin 16
…
Next

Doctors: 10 lessons from the humble bumblebee

December 7, 2013 Kevin 4
…

Tagged as: Palliative Care

Post navigation

< Previous Post
It's a fearful time for medical students
Next Post >
Doctors: 10 lessons from the humble bumblebee

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Gene Uzawa Dorio, MD

  • How doctors took back control from hospital executives

    Gene Uzawa Dorio, MD
  • Pope Francis dies at 88. What his care reveals about America’s failing hospitals.

    Gene Uzawa Dorio, MD
  • When saving lives leads to losing your own

    Gene Uzawa Dorio, MD

More in Physician

  • How a rainy walk helped an oncologist rediscover joy and bravery

    Dr. Damane Zehra
  • How inspiration and family stories shape our most meaningful moments

    Arthur Lazarus, MD, MBA
  • A day in the life of a WHO public health professional in Meghalaya, India

    Dr. Poulami Mazumder
  • Why women doctors are still mistaken for nurses

    Emma Fenske, DO
  • Adriana Smith’s story: a medical tragedy under heartbeat laws

    Nicole M. King, MD
  • Why U.S. health care pricing is so confusing—and how to fix it

    Ashish Mandavia, MD
  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • Mastering medical presentations: Elevating your impact

      Harvey Castro, MD, MBA | Physician
    • Why the pre-med path is pushing future doctors to the brink

      Jordan Williamson, MEd | Education
    • Why what doctors say matters more than you think [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden incentives driving frivolous malpractice lawsuits

      Howard Smith, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
  • Recent Posts

    • Why the pre-med path is pushing future doctors to the brink

      Jordan Williamson, MEd | Education
    • Why the fear of being forgotten is stronger than the fear of death [PODCAST]

      The Podcast by KevinMD | Podcast
    • How a rainy walk helped an oncologist rediscover joy and bravery

      Dr. Damane Zehra | Physician
    • How inspiration and family stories shape our most meaningful moments

      Arthur Lazarus, MD, MBA | Physician
    • A day in the life of a WHO public health professional in Meghalaya, India

      Dr. Poulami Mazumder | Physician
    • Why women doctors are still mistaken for nurses

      Emma Fenske, DO | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 6 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • Mastering medical presentations: Elevating your impact

      Harvey Castro, MD, MBA | Physician
    • Why the pre-med path is pushing future doctors to the brink

      Jordan Williamson, MEd | Education
    • Why what doctors say matters more than you think [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden incentives driving frivolous malpractice lawsuits

      Howard Smith, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Bureaucracy over care: How the U.S. health care system lost its way

      Kayvan Haddadan, MD | Physician
  • Recent Posts

    • Why the pre-med path is pushing future doctors to the brink

      Jordan Williamson, MEd | Education
    • Why the fear of being forgotten is stronger than the fear of death [PODCAST]

      The Podcast by KevinMD | Podcast
    • How a rainy walk helped an oncologist rediscover joy and bravery

      Dr. Damane Zehra | Physician
    • How inspiration and family stories shape our most meaningful moments

      Arthur Lazarus, MD, MBA | Physician
    • A day in the life of a WHO public health professional in Meghalaya, India

      Dr. Poulami Mazumder | Physician
    • Why women doctors are still mistaken for nurses

      Emma Fenske, DO | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

We’re already throwing grandma under the bus
6 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...