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Old 01-27-2015, 10:50 AM
 
143 posts, read 132,737 times
Reputation: 802

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Quote:
Originally Posted by Northern Maine Land Man View Post
This should not surprise anybody. We knew when Obama pushed his Obamacare plan on our nation that there were going to be "death panels". These are just the procedures and if a hospital doesn't make enough old folks die there will be severe penalties for the hospital, the physicians and the administrators. To complete his fundamental changes to our nation they need to get rid of people who actually remember freedom, prosperity and liberty.
"Freedom and liberty" to me means (among other things) that I retain the ability to make an informed decision about my fate. The "Death Panel" myth was a politically expedient creation that served to kill a provision in the ACA that allowed for the reimbursement of physicians for providing counseling for the terminally ill. The idea was that the doctor, patient and/or family would discuss the current medical status, prognosis and treatment options--along with the side effects of such treatment and the quality of life issues going forward. I have known so many patients that reluctantly agree to treatment at the urging of their doctors or families (mine included) who are desperate to keep them alive at any cost or with any measure... even when the patient no longer wishes to continue on. A caring, compassionate and informative discussion with all involved would at least ensure that everyone has what they need to make a decision, and perhaps facilitating a discussion that some patients and their families never have. If the patient, family or the patient's "Advanced Health Care Directive" says "keep me alive and spare no expense" then that is what will (and does) happen.

If we want to save Medicare, and regain some of our "prosperity" we are going to have to have this discussion sooner or later. A large portion of Medicare resources are expended in the last six months of life as discussed here:

End-Of-Life Care: A Challenge In Terms Of Costs And Quality | Kaiser Health News

I thought the most telling portion of the article was this"

"In 2011, Medicare spending reached close to $554 billion, which amounted to 21 percent of the total spent on U.S. health care in that year. Of that $554 billion, Medicare spent 28 percent, or about $170 billion, on patientsí last six months of life (Pasternak, 6/3)."


I will always remember the author James Michener, who at age 90 decided to end his dialysis treatments and passed a week later. He had said he was "old, ill and tired." I loved his books and admired his decision.
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Old 01-27-2015, 12:14 PM
 
Location: California
4,556 posts, read 5,473,472 times
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One of the most intelligent friends I ever had watched her DH die from cancer. When she also was diagnosed with cancer her mind was already made up...no treatment, no doctor visits, no hospice only common asprin for pain. One day I made the mistake of trying to talk to her about getting care and for the first time ever, she yelled at me. To this day I can still her yelling "I don't need a doctor to tell me how to die". Her words still hurt me, but they were the right thing for her to do. I was being selfish as I didn't want to lose my precious friend or see her in agony. She never changed her mind and I will always miss her.


We have been on Medicare for just over a year now so as taxpayer, and consumer, I am disgusted at what doctors in the Bay area charge Medicare for routine care. I really don't want to be on their food chain so I hope to avoid them as much as possible. Pallative care is all I want from my perspective today.
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Old 01-27-2015, 12:16 PM
 
Location: Location: Location
6,352 posts, read 7,831,222 times
Reputation: 18584
Quote:
Originally Posted by fay111 View Post
My own experience with family members is that doctors often take their "cues" from what the patient/family members ask/don't ask. If you are a person who indicates you want everything done to extend life, in many cases that is what you will get. If, on the other hand, you ask questions indicating that you want to know all the pros/cons of procedures and treatments and if you do some research on your own, doctors will be very forthcoming.

An example was my father when he was diagnosed with cancer. He decided to have surgery, but went into it fully informed of the risks/upsides of it. A side effect of his cancer was hyper-calciumia (the body producing too much calcium which resulted in mental confusion). He got through the surgery fine, and had pretty good quality of life for awhile.

At some point, his calcium levels rose again, and I knew the cancer was back - and that it was inevitably fatal. I travelled up to consult with his doctor, because I didn't want them to subject him to lots of invasive tests (and knew that he wouldn't want that as well). We came to an agreement that he would enter hospice and get no further treatment. His doctor was totally on board with that, as she knew him well and knew that is what he wanted.

I think if I had pushed for them to do whatever possible to extend his life, they probably would have.

I'm sometimes shocked by friends who have ill family members, and realizing that they have absolutely no knowledge of treatment options, survival times, etc. They don't do any research and don't ask questions of the doctors. I think these are the type of situations that often result in over-treatment.

As a patient, you have the right to question every treatment and get second opinions - if a doctor won't discuss your situation, then it's time to find a new doctor.
Fay your last sentence says it all. Sadly, some people won't exercise the right to ask questions because they don't want to know. "Just fix me." I have had a couple of heavy-duty surgeries in the past 10 years and I went into both knowing just about all I could - both times explained to me by the surgeons who would be doing the cutting and second opinions and independent research - and assured both times that the prognosis was excellent for recovery. I did. Recover, that is. And I'm 10 years out from open-heart and six years out from colon cancer. I fully expect if I continue to live, something is going to bite me, and I'll decide then how much intervention I want. And my doctor knows me well enough that he wouldn't leave me with false hope.

I firmly believe that everyone, regardless of current health status, should have Advance Directives in place. And every consumer should be interested in having all the information available; whether what you're buying is a new TV, or a car, or a procedure that may or may not return you to your previous state of health.
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Old 01-27-2015, 01:05 PM
 
Location: Lakewood OH
21,697 posts, read 23,672,920 times
Reputation: 35449
Quote:
Originally Posted by Heidi60 View Post
One of the most intelligent friends I ever had watched her DH die from cancer. When she also was diagnosed with cancer her mind was already made up...no treatment, no doctor visits, no hospice only common asprin for pain. One day I made the mistake of trying to talk to her about getting care and for the first time ever, she yelled at me. To this day I can still her yelling "I don't need a doctor to tell me how to die". Her words still hurt me, but they were the right thing for her to do. I was being selfish as I didn't want to lose my precious friend or see her in agony. She never changed her mind and I will always miss her.


We have been on Medicare for just over a year now so as taxpayer, and consumer, I am disgusted at what doctors in the Bay area charge Medicare for routine care. I really don't want to be on their food chain so I hope to avoid them as much as possible. Palliative care is all I want from my perspective today.
I hear that. I have been going to the Cleveland Clinic for the past six months and have racked up thousands of dollars worth of bills just for outpatient care. Yesterday I got a bill that is impossible to figure out for $12,137. I called the clinic and no one can tell me what the service is for.

I told them fine, until you can tell me what it's for, I am not going to pay it. They are sending me a form to fill out for financial hardship. But not a penny until they decipher a bill that even their own customer assistance service person couldn't figure out.

Food chain indeed. And they are dining on caviar and lobster.
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Old 01-27-2015, 01:18 PM
 
338 posts, read 625,540 times
Reputation: 568
Quote:
Originally Posted by theatergypsy View Post
Fay your last sentence says it all. Sadly, some people won't exercise the right to ask questions because they don't want to know. "Just fix me." I have had a couple of heavy-duty surgeries in the past 10 years and I went into both knowing just about all I could - both times explained to me by the surgeons who would be doing the cutting and second opinions and independent research - and assured both times that the prognosis was excellent for recovery. I did. Recover, that is. And I'm 10 years out from open-heart and six years out from colon cancer. I fully expect if I continue to live, something is going to bite me, and I'll decide then how much intervention I want. And my doctor knows me well enough that he wouldn't leave me with false hope.

I firmly believe that everyone, regardless of current health status, should have Advance Directives in place. And every consumer should be interested in having all the information available; whether what you're buying is a new TV, or a car, or a procedure that may or may not return you to your previous state of health.
Totally agree with you on the Advance Directives - DH and I just recently updated ours and parts of it I found difficult to express my wishes, because while I know when I would definitely not want any intervention, some areas are somewhat "gray" and would depend on very individual circumstances.

And that is true of a lot of medical situations. Up-thread someone mentioned heart valve surgery not working out on a member of their family. My MIL had aortic valve replacement at 89, and is still going strong at 95. In her case, she was otherwise in very good health and after consulting with several doctors and doing our research, the decision was made to have it. Part of that reason was that the alternative was not very pleasant. Usually there are increasing hospitalizations due to fluids needing to be drained. In my MIL case, she also started fainting and we worried about her falling and breaking bones. The surgeon who operated on her said that in many cases he did not recommend the surgery due to other health issues, but that she was a very good candidate.

So again, every situation is different and everyone should get all the information they can so as to make the best informed decision possible.
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Old 01-27-2015, 02:54 PM
 
Location: California
4,556 posts, read 5,473,472 times
Reputation: 9616
Quote:
Originally Posted by Minervah View Post
I hear that. I have been going to the Cleveland Clinic for the past six months and have racked up thousands of dollars worth of bills just for outpatient care. Yesterday I got a bill that is impossible to figure out for $12,137. I called the clinic and no one can tell me what the service is for.

I told them fine, until you can tell me what it's for, I am not going to pay it. They are sending me a form to fill out for financial hardship. But not a penny until they decipher a bill that even their own customer assistance service person couldn't figure out.

Food chain indeed. And they are dining on caviar and lobster.
My grandma, uncle, dad and me were all CC patients at one time or another. I'm sorry to see that they have apparently slid down since then. In today's climate, it is wise to keep careful records of everything.
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Old 01-27-2015, 03:01 PM
 
Location: Northern Maine
9,777 posts, read 14,957,778 times
Reputation: 9588
"In 2011, Medicare spending reached close to $554 billion, which amounted to 21 percent of the total spent on U.S. health care in that year. Of that $554 billion, Medicare spent 28 percent, or about $170 billion, on patients’ last six months of life (Pasternak, 6/3)."

Of course, that is true. You need treatment when you are sick, not when you are well. I was born before WWII. I work every day because I like to eat. In my life so far I have had three prescriptions - that's it; Three. If I am injured I want to get well and go back to work. I don't want some functionary who does not know me to decide I should die because of a spreadsheet created by progressives in the Obama Administration.
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Old 01-27-2015, 03:04 PM
 
Location: Near a river
16,042 posts, read 18,982,141 times
Reputation: 15649
Quote:
Originally Posted by Minervah View Post
My cousin and dad would have benefited from this. Both were in the hospital clearly dying but had to suffer the agonies and humiliation of tests, being poked and prodded and awakened at all hours of the night for more tests which were useless. There was no treatment that was going to save them. My dad was fading from a rare incurable disease and my cousin from terminal Cancer.

They should have been in hospice but neither had arranged for it. With a test like this, it might have spared them the agony of all this.

There should be some criteria that would help the patient and his or her family to make an informed decision as to when to say "enough is enough" when it comes to treatment.
Maybe the best thing we could ever hear, as patients, is "Go home, there's nothing we can do for you." Once home, follow our instincts, eat or not eat, watch racy movies, have sex and champagne, spend like a drunk, and in the end, either we will revive or we will have died better than if we had stayed in hospital with all those invasive agonies.
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Old 01-27-2015, 03:28 PM
 
143 posts, read 132,737 times
Reputation: 802
Quote:
Originally Posted by Northern Maine Land Man View Post
"In 2011, Medicare spending reached close to $554 billion, which amounted to 21 percent of the total spent on U.S. health care in that year. Of that $554 billion, Medicare spent 28 percent, or about $170 billion, on patientsí last six months of life (Pasternak, 6/3)."

Of course, that is true. You need treatment when you are sick, not when you are well. I was born before WWII. I work every day because I like to eat. In my life so far I have had three prescriptions - that's it; Three. If I am injured I want to get well and go back to work. I don't want some functionary who does not know me to decide I should die because of a spreadsheet created by progressives in the Obama Administration.
If you are sick or injured, can be successfully treated and return to work, I think you can be confident you will receive whatever treatment you require to achieve that goal. What we are talking about here are people that are clearly dying. I think this test is a reasonable step, as are more frank and honest discussions about how hard we should cling to life as the quality of that life dissolves. It is ultimately an individual decision, but it has large societal ramifications.
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Old 01-27-2015, 04:20 PM
 
143 posts, read 132,737 times
Reputation: 802
Quote:
Originally Posted by newenglandgirl View Post
Maybe the best thing we could ever hear, as patients, is "Go home, there's nothing we can do for you." Once home, follow our instincts, eat or not eat, watch racy movies, have sex and champagne, spend like a drunk, and in the end, either we will revive or we will have died better than if we had stayed in hospital with all those invasive agonies.
Oh my. I hope my future condition(s) will allow this. Especially the sex and champagne part...

Last edited by northwesty; 01-27-2015 at 04:34 PM..
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