Tuesday, January 12, 2010

No Incentives for Docs to Talk about End of Life

John Carney
January 12, 2010

The reasons doctors don't discuss advanced progressive disease and declining health status with patients more often is that there is no incentive to do so.

Providers get paid to treat, and patients who are willing to undergo progressively burdensome interventions, hoping against hope, get their treatments covered. Docs rarely talk about acute or chronic disease process in stages (early, mid and advanced) even with patients of advanced age.

Patients don't ask. Doctors don't tell.

For years, those of us who've dedicated our lives to improving life in its final chapters resort to blue humor and sad references that Americans are the only people on earth who consider death an optional event. It isn't a laughing matter.

Redirecting goals of treatment to realistic achievable outcomes isn't rocket science Neither is is talking about progressive disease, realistically and compassionately. It may take longer than not talking, but until we value the professional relationship enough to pay for the conversation, it will remain elusive.

We must reframe the conspiracy of silence from its current notion of acceptability to the deceptive practice it is, depriving all of us of the patient autonomy we claim as sacred.

If healthcare reform does nothing more than help realign payment incentives to the point that doctors and patients can abandon magical thinking and address advanced disease more honestly, then maybe something good for both patient and provider can come from the last nine months.
For the eventual and humorless outcomes we all face, it's time.




Blogger Practical Bioethics said...

I am somewhat concerned by the phrase "doctors and patients can abandon magical thinking and address advanced disease more honestly."

There is a spiritual and theological dimension in end of life decisions which is not at all "magical" to believers, and trying to deal with end of life matters on a purely secular basis is not helpful or appreciated by patients who are committed to their faith in things which are unseen yet objectively realities, and are unshakable in their belief that actions in this life have consequences in eternity.

In my experience as a health care provided (a D.D.S. with two hospital based residencies) in a family which includes four physicians - all specialists, it seems that physicians are ill equipped indeed to deal with the spiritual dimensions of end of life care.

That sort of thing is not touched upon in their training. One relative, an Emergency Medicine specialist and Trauma Surgeon once told me that when that sort of thing comes into play, she just calls a chaplain. That is appropriate.

There are spiritual, religious, and ethical issues related to religion that come into play in end-of-life counseling that make it unwise to approach that kind of counseling except in a multidisciplinary approach which includes heal care providers and clergy.

Yours in the fellowship of Our Lady, the Mother of the Church, Most Rev. Irl A. Gladfelter, C.S.P., (D.D.S.,) M.Div., S.T.M., D.D.
Metropolitan of the Anglo-Lutheran Catholic Church St. Michael's House 1200 N.E. Terrace Kansas City, MO 64118-1361
Chancery: (816) 468-9691
E-mail: ALCClutherans@kc.rr.com

Wednesday, January 13, 2010  

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