Are Americans Overtreated to Death by the Medical Establishment?

A truly valuable article from the AP today "Americans are treated, and overtreated, to death".  The article stares down a hard question - When do we stop focusing on a cure and start caring about how we die?

The statistics are disturbing:

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 than 80 percent of people who die in the United States have a long, progressive illness such as cancer, heart failure or Alzheimer's disease.

More than 80 percent of such patients say they want to avoid hospitalization and intensive care when they are dying, according to the Dartmouth Atlas Project, which tracks health care trends.

Yet the numbers show that's not what is happening:

The average time spent in hospice and palliative care, which stresses comfort and quality of life once an illness is incurable, is falling because people are starting it too late. In 2008, one-third of people who received hospice care had it for a week or less, says the National Hospice and Palliative Care Organization.

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Deirdre R. Wheatley-Liss is a shareholder of the Law Firm of Fein, Such, Kahn & Shepard, P.C., with offices in Parsippany and Toms River, New Jersey. She concentrates her practice in the areas of Elder Law, Estate Planning and Administration, Business Planning and Tax Law. Deirdre's individual clients range from their 20's to their 80's and beyond, while her business clients range from start-ups with exciting new ideas to 100+ year old business ventures. Clients seek Deirdre's advice and assistance with a variety of planning issues relating to identifying and meeting their personal, family and business goals, whether in a planning or crises situation.

 

Hospitalizations during the last six months of life are rising: from 1,302 per 1,000 Medicare recipients in 1996 to 1,441 in 2005, Dartmouth reports. Treating chronic illness in the last two years of life gobbles up nearly one-third of all Medicare dollars.

Do we want to tell people they can't be treated for their disease because .... (fill in the reason - money, age, citizenship, whatever?).  I don't think so.  However, what is missing from the discussion about terminal disease is how do you care for it as opposed to how do you cure it, because there may not be a cure.  Death is part of life - harsh and unwanted and soul-destroying as it may be, it is and always will be the end.

The article suggest that an answer to all of these disturbing questions may start in a conversation - a real back and forth dialog with all parties being fully informed - of what it means to battle a disease or care for it.  

So where do you go to have that dialog? In a conversation I had with David J. Shulkin, MD, Chief Operating Officer and President-elect, Morristown Memorial Hospital a few weeks ago he suggest patient message boards.  He believes that patients need to be active participants in their own health care, and part of that is leveraging the experience of other dealing with the disease is addressing the "cure" v. "care" question.