Let’s say you’re really old. Or you’re really ill. And you want to discuss end-of-life care with your doctor.
What do you do?
Make an appointment? Phone and ask to speak to your physician? (Good luck…)
Wing it, without a doctor’s help or advice?
Well Section 1233 of the new proposed health care bill drafted by the House of Representatives proposes actually paying doctors for such a vital discussion with an old patient every 5 years. Or even more often if a patient is seriously ill.
What do I call this provision? Common sense.
What do the scare-mongers call it? A Granny-Killer.
And by scare-mongers I am not including simply a bunch of right-wing kooks. Last week a Washington Post columnist also voiced concerns that this proposed provision might be used as just another way of snuffing seniors.
“If it’s all about obviating suffering, emotional or physical, what’s it doing in a measure to “bend the curve” on health care costs?” writes Charles Lane.
What’s it doing in that bill? Because, as we all know, important (and sometimes dumb) provisions are often tacked onto bills, whether or not the provisions are at all relevant to the ultimate goal of those bills.
Frankly, I’m not certain that a government paying for explicit and necessary end-of-life discussions with a patient will in fact reduce health care costs. Remember: the issue is the doctor gets paid by the government for every one of such candid talks, so a reduction in total medicare costs is iffy. At best.
But I am sure that how people die — be it hooked up to machines, or pumped full of pain-killers, under hospice care or in a hospital — is very important to all of us. We all want to be in charge up to the very end, and if we can’t be we at least want to voice our desires for that end while we’re still able.
Think about it: Only one-third of all American have written Living Wills detailing what measures they want (or don’t want) in their final months or days of life. Many of these Living Wills are actually ignored or dismissed out of hand by the very doctors who treat us at the end.
At the very least this kind of government decision to pay doctors to talk to patients — pay them, in other words, to actually listen to us — will ensure that more of us can express our wishes, and get those wished honored.
Wow, Judy what a timely subject. You are so right and I agree that the point of the provision is not to “convince” any patient or family to abandon care or hope. Is is about being able to pay the physicians for the time it takes to actually sit down and have an intelligent, non judgemental and meaningful discussion about the patients current condition, quality of life and future goals. As a hospice/palliative nurse, I have had these discussions with families and patients after they have received a “terminal dx”. It can take HOURS, and I generally book myself for 1.5 to 2.0 hours to have one of these discussions. It is not something that a physician can discuss with a patient in 10-15 minute increments. Conditions change and patients and families need to revisit this issue from time to time. The decision is ALWAYS with the patient, the family and the physician…..not with the payor source be it insurance or a government office. I take the bill to mean that we will be requested to revisit this issue as the patient moves through this journey. It seems the right thing to do, but never based soley on cost of care, more so on the quality of life, chosen goals and possible futility of medical treatment. Sorry I went on so long…..
Dismissing those who disagree with you as “rightwing kooks” is hardly productive. Thewre are legitimate concerns when the government (who can’t seem to manage anything effectively), controls the purse strings on yet anothewr aspect of our personal lives that should be left at that.