Anyone with even the slightest passing interest in health care, has heard the mind-blowing statistics. As a nation, we spend almost 3.5 trillion dollars on health care. To put that into perspective, that is more than the total GDP of every country in the world apart from China and Japan! Germany, next on the list, has an entire GDP of 3.4 trillion dollars. At 18 percent of the economy, we …
3 ways to fix end-of-life care
Harry understood at last that he was not supposed to survive. His job was to walk calmly into Death’s welcoming arms … All those times he had thought that it was about to happen and escaped, he had never really thought of the thing itself: His will to live had always been so much stronger than his fear of death … It was over, he knew it, and all that …
The lessons of Harry Potter and the Deathly Hallows
Why do we want to become doctors? What was our main motivation that we have written in our motivation letters and repeated in our interviews? Regardless of the specific incident or the general motivation, it can be all summarized in one sentence: We are here to save lives. After all, this is what the physicians do, isn’t it?
Preventing deaths is actually hinted to by the original Hippocratic Oath, written between …
We need to accept our failure as doctors
In loving memory of my grandfather, my first physician mentor.
Earlier this year, my 90-year-old grandfather passed away unexpectedly after undergoing transcatheter aortic valve replacement (TAVR). Similar to many elderly patients who die each year in the United States, his death was preceded by a litany of costly and time-consuming tests and treatments. Despite this extensive workup, the end of his life was shadowed by suffering left unaddressed. But, unlike the …
We all treat the whole patient. We must avoid tunnel vision at all costs.
Looking at how incredibly expensive the last few months of life are for anyone in this country, I think most would be quite shocked. In 2014, there were approximately 2.6 million deaths in the U.S. According to a Keiser Permanente study, 2.1 million of those deaths were Medicare related. Medicare’s annual budget is right around $600 billion, and it has been revealed that one-third of that total is spent in …
Why we need a new approach to end of life care
An excerpt from Cancer What You Need to Know.
Treating cancer means taking care of the whole patient — the physical, the emotional, and the spiritual. This starts at diagnosis and carries through treatment and beyond.
Unfortunately, for some patients, cancer does find ways to spread that can cause physical pain, …
All cancer care needs to consider the whole patient
“We are what we repeatedly do. Excellence, then, is not an act but a habit.”
– Will Durrant, historian
For better or worse, all of my high school English teachers were memorable. Each held a precise but non-overlapping image of the perfectly crafted essay; therefore, every September I found myself adopting a brand new writing style. A paper that would have garnered an “A” at the end of one school year routinely received …
A teacher’s calling never ends
America’s opioid crisis is getting worse. The role of prescription opioids has both the medical establishment and the government justifiably worried.
In response, the National Academies of Science, Engineering and Medicine released an official report on the crisis earlier this year. And, on September 21, the National Academy of Medicine released a special publication calling clinicians to help combat the crisis.
As a bioethicist working on …
An ethical dilemma for doctors: When is it OK to prescribe opioids?
I’m a physician, a husband and dad, a guy who tries to live by the golden rule. But sometimes I’m an escort into sadness and despair, plunging families into the darkest emotional depths with the news I must give.
One particular case from years prior stands out. Mary (whose name and identifying details have …
The toughest task in emergency medicine
In a terrible twist of fate, the very day that the Centers for Medicare & Medicaid Services (CMS) Hospice Compare website went live, I found myself in a pulmonologist’s office with my parents, taking in the news of my mother’s advanced cancer and malignant pleural effusion. The shock of it, and the uncanny timing are beyond comprehension. You see, I’ve been leading research at RTI International and …
Am I the first user of the Hospice Compare website?
Nothing seemed to help the patient — and hospice staff didn’t know why.
They sent home more painkillers for weeks. But the elderly woman, who had severe dementia and incurable breast cancer, kept calling out in pain.
The answer came when the woman’s daughter, who was taking care of her at home, showed up in the emergency room with a life-threatening overdose of morphine and oxycodone. It turned out she was high …
Dying at home: The problem hospices have with stolen opioids
We all practice medicine for different reasons. Of course, it’s almost reflexive to say we practice medicine because we care about people. I’m sure this is true for many physicians. However, if I were being honest, I think I went into medicine more because of the educational challenge. In addition, the profession yielded respect, status, money (back in the day!) and yes, an opportunity to help. I won’t challenge my …
What I learned as a hospice director
Charlie Gard was a one-year-old boy who had a rare genetic disease leaving him blind, comatose, and unable to breathe on his own. This metabolic disorder can be fatal and has no known cure.
Charlie’s parents wanted him treated with experimental drugs in the hope that a miracle would happen. As reported in the press, the British medical and legal community considered this care futile and blocked …
Planning for the end of life: What baby Charlie can teach us
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Sheila’s jaw is clenched. Sweat is beading on her forehead. I make a slow audible inhale, non-verbally inviting her to do the same. We’ve been talking about the nightmares which started shortly after she began receiving help with personal care. I remind her that she is safe — the day she was raped is decades in the past. Her conscious mind knows this, of course, but for people with posttraumatic …
PTSD can happen at the end of life
My partner Judith had pain in her sinus cavity caused by a tumor called a plasmacytoma. After her biopsy, her surgeon called Friday afternoon with the results. She asked him to wait fifteen minutes until I could be home with her to get the news. He had no flexibility and said he could speak either then or Monday. She chose to speak with him then on the phone still alone. …
12 tips for giving patients bad news
He had cardiomyopathy and CHF for over 20 years. At the time, doctors told him he could die at any time. That was 20 years ago. His EF was 10 percent — barely livable.
Two decades later, this admit kept him on a see-saw with respiratory distress, a bad heart, bad lungs, atrial fibrillation with RVR and heart rate in the 140s all day long. He progressed from nasal cannula to …
My husband, the anesthesiologist, came home one evening, he was solemn, affected, not himself. His patient died in the recovery room. It was sudden and unexpected for my husband. Despite the team’s swift efforts and perfectly executed code, the patient died anyway. It’s relevant to note that his patient was an almost 90-year-old man with significant congestive heart failure, probably chronic kidney disease, and complete occlusion of one of his …
5 ways to make dealing with death easier
There have been recent discussions in the lay media about a growing trend of litigation cases focused not on the “right to live,” but rather on the “right to die.” These cases have involved patients who received aggressive treatment, despite having documentation of their wishes not to receive such aggressive treatment. Although unsettling, it is not surprising that this issue has arisen, given the national conversations about the exorbitant cost …
Important considerations in how we use advanced care planning documentation
Whether you believe in science, God, neither or some combination of the two — we can all agree that death is inevitable. Due to the finality of our lives, each of us should understand and prepare for that moment not only for ourselves but also for our loved ones. As medicine continues to advance and people live longer, we have a generation of baby boomers who are now entering their …
End-of-life planning isn’t fun, but it’s inevitable
My friend and neighbor died last week. In his early eighties, wiry, opinionated, well-read, he never tolerated schooling. He built an excavating business with a perfected aesthetic for contouring soil and also built a few homes in town including mine. When he saw the architect’s lower pitched roof framed on the garage, he had it torn off because: “It just wasn’t right. It looks like a tiny bowler hat on …
Hospice and palliative care are bringing dying back to life
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