Americans are treated, and overtreated, to death

Americans are treated, and overtreated, to death
AP


This undated photo shows Rosaria Vandenberg, right, with her husband John and daughter Alessia. After Rosaria lost her battle with cancer in the hospi AP –

By MARILYNN MARCHIONE, AP Medical Writer



The doctors finally let Rosaria Vandenberg go home.

For the first time in months, she was able to touch her 2-year-old daughter who had been afraid of the tubes and machines in the hospital. The little girl climbed up onto her mother's bed, surrounded by family photos, toys and the comfort of home. They shared one last tender moment together before Vandenberg slipped back into unconsciousness.

Vandenberg, 32, died the next day.

That precious time at home could have come sooner if the family had known how to talk about alternatives to aggressive treatment, said Vandenberg's sister-in-law, Alexandra Drane.

Instead, Vandenberg, a pharmacist in Franklin, Mass., had endured two surgeries, chemotherapy and radiation for an incurable brain tumor before she died in July 2004.

"We would have had a very different discussion about that second surgery and chemotherapy. We might have just taken her home and stuck her in a beautiful chair outside under the sun and let her gorgeous little daughter play around her — not just torture her" in the hospital, Drane said.

Americans increasingly are treated to death, spending more time in hospitals in their final days, trying last-ditch treatments that often buy only weeks of time, and racking up bills that have made medical care a leading cause of bankruptcies.

more...

http://news.yahoo.com/s/ap/20100628/ap_on_he_me/us_med_overtreated_final_days

A very frank discussion about whether aggressive treatment will buy extra good time or just ruin the time a patient has left would be preferable, but too many oncologists are knights on white horses, trying to slay the cancer dragon.

People with young children are likely to agree with those knights, grasping at futile treatments in a desperate attempt to buy time to see those children grow up. They would have had more good time with their children had they decided to let nature take its course and opt for palliative measures, only, but the temptation to try for that one chance in a thousand is often too great.

Fuller disclosure of the cost of treatment to a person's life must be made, along with completely full disclosure of the potential benefit, or lack thereof.

Chances are Ms. Vandenberg would have made the same decision, but it's unlikely she was given a clear choice. People need to be given that choice.

cancer because parents tried out last ditch efforts for their children 20 and 30 years ago. People need to know, though, whether there is real hope or whether the knowledge will only benefit future patients. Sometimes a person is too far gone to be really helped by a new treatment, but the information gleaned by the attempt will help other people.

unless it's an experimental protocol, something I worked with years ago.

Reasons for undergoing last ditch and usually futile therapy that destroys one's quality of life are complex. I'm only asking for what the OP did, full disclosure that such might be the case.

A lot of the doctors I have worked with felt very uncomfortable...afraid...to discuss DNR as an alternative.I would ask the doc if this was an option,and follow him into the patient's room,and initiate this discussion.Sometimes,they need support of the staff to begin the discussion.The nurse is there when the doc leaves,and should be actively involved in the discussion...just my 2 bits...

as part of the admission interview. The hospital chaplain would take care of the paperwork if the people were interested in completing it.

Doctors often want to be seen as heroes and heroes never give in to the inevitable.

goal to collect data so doctors had accurate information for patient discussions. For example, "85% of people at this stage who go into the ICU die in 3 days, while 85% of those at this stage who don't go into ICU die in 2 days." That would allow the family and patient to balance a death in a noisy place among strangers vs. a quiet death at home with family. As it is now, people think they are choosing between life and death, not between dying one way or another.

That would give patients,families and doctors the info they need to make a confident decision. After a person dies following a long illness or even a sudden accident such as stroke or heart attack, the family is often left wondering "Could more have been done?" "did we pull the plug too soon?" "Did we cause Dad to suffer by leaving them hooked up to machines instead of letting him go quietly?" "Should we have talked Mom into that last surgery?"

I don't know if the data collection proposals made it into the final bill, but I hope so.

Say 10% of the patients survive, how do you know which people fall into the 10%? If you could say that this person would benefit from a stay in the ICU and that person will only endure 110 days of suffering before dying in the ICU, we'd all have an easier time making decisions.

once you get suckeed in. how much money is drained. advances are great, but sometimes, you will not live. we need options.

All too often, doctors (and patients) are so convinced that death is to be avoided at all costs. But death is part of life--and we're all going to experience it.

If the only choice is to fight and delay death, then quality of life is a moot point. But if we accept that death is inevitable, and our choice is about how to go, not whether to go, then some more humane options become possible. That many of those humane options are less expensive ought to be irrelevant; what's important is having humane options.

There was a piece along these lines in the New York Times Magazine a couple of weeks back: What Broke My Father's Heart.

Strange how that works

No insurance gets you the most basic emergency treatment in a crowded ER. Good insurance buys you painful and life-threatening treatment you may not need.

I had a gynecologist try to stampede me into a hysterectomy I didn't need. The only reason I still have all my parts is that I was willing to assert myself.

faced with a given set of facts. It's partly because they tend to have the same training and partly because they tend to pick up on and follow the local practice. As a result, hysterectomy rates vary with region. I imagine the same applies to other medical decisions. For example, is it better for a person with a certain set of symptoms to have by-pass surgery or would a combination drug/diet/exercise therapy be better? The answer should depend on actual results rather than how many cardiac surgeons are in an area and what kind of insurance a patient has.

This is another example of why we need data collection.

people are kicked out of the hospital days, or even weeks before they're ready, sometimes even if its dangerous to do so. Bizarre system.