When patients and family members say. "We want everything possible done."?
Risking some angry responses here. I heard this quite often as an oncologist - "We want everything done.". But these days there are so many more things that can be done and many treatments are very expensive with no chance of cure. I specifically recall the family of a 96 year old woman with widespread incurable gastric carcinoma. They wanted "everything done." The patient could not speak for herself. With health care reform focusing on cost containment, who will tell doctors and patients/families that it is not cost effective to do everything possible? Insured Americans - third party & Medicare - are often accustomed to having "everything done" regardless of costs. In the 1980's and 1990's, Medicare did not tell us we couldn't try aggressive chemotherapy in 96 year old patients. Who should make these decisions - doctors, distraught families, or the government?
The trouble is that some (not all) oncologists will treat everyone rather than explain why treatment is not advisable. Some because that's how they make money, and some because it's easier to treat than to spend the time explaining. The good news is that we have many more new treatments for cancers. The bad news is that they are incredibly expensive. Who will limit care rationally in these emotional situations?
I'm referring to the U.S. health care system.
Also - after extensive discussion - I was able to talk that family out of putting that 96 year old woman through aggressive chemotherapy which was far more likely to do harm rather than good. For non-medical people out there, there is zero chance of a "cure" with chemotherapy in widespread gastric carcinoma.
http://patient.cancerconsultants.com/CancerTreatment_Gastric_Cancer.aspx?LinkId=53917
If you look at these combination chemotherapy choices, think about how well a 96 year old nursing home patient would tolerate these. And should these national health care dollars be spent here - or on better health care for children? I don't think we can afford to do everything for everyone with today's medical advances. This means some degree of rationing which I suspect is part of accepted life in Britain and Canada.
"everythi." - I like your thinking, I just want to see people's thinking. A young person with head trauma is very different from the 96 year old person with widespread gastric cancer. I only chose one example, but I have seen many thousands of others. Whatever malignancy you defeated was obviously the case of a younger woman. I have seen a few miraculous recoveries among the thousands of persons I saw with advanced cancers. Can we in the U.S. afford to go all out treating 100 people to help just the one who might have the miracle response? What about a 5% chance of response? 10%? At what age do we say it's OK to not spend hundreds of thousands of $$$ on desperate cancer treatment measures? If 96 is OK by you, how about 93? 88? Where do we draw the lines?
Can we spend the entire federal budget doing everything possible for everyone? I would love to do that in an ideal world with unlimited resources for all people. Also, I've never pretended to be God.
I agree that pharmaceutical companies, health insurance companies, medical supply companies, and some doctors not make obscene profits from medical care. I was on a salary of ~$80,000 per year the last six years of my medical practice. I didn't think $80,000 per year was excessive after 13 years of training to become a hematologist oncologist. The trick is how to regulate the greed and excess profit taking with health care reform.
WOW, Panda - I am certainly not talking about withholding treatment for a young person like your son. I think the money should be spent on the young. We spend so much on our increasingly elderly U.S. population. I knew this might strike some nerves. The discussion is good. Where do we make cutbacks? Increasing Medicare and Medicaid costs are unsustainable now - even without covering the uninsured Americans. There has to be some form of rationing - and we won't like it. That's my point. We were usually allowed to "do everything possible" in the 1980's and 90's. Those days appear numbered unless everyone charges much less.
"BSherman" has exactly the kind of thoughtful answer I was looking for. The latest bill in the U.S, House of Representatives reportedly has nothing included about malpractice reform. Some U.S. doctors order every test and "do everything possible" to avoid malpractice suits. Some people in the U.S. expect everything - including perfection. If something goes wrong, big money is expected - as if that assuages the loss of a loved one.
"Randy" has an amazingly thoughtful answer. I can't believe three people would give him thumbs down, but I have never understood the thumbs down part of this site. I never give anyone a thumbs down.
"Denisedd" has raised another excellent point. The family members of the 96 year old woman I mentioned would not have pushed to have "everything done" if THEY had had to provide the tens of thousands of dollars to pay for it. That's when people back off. This nice lady was going to die soon no matter what I did or how much money we spent trying to postpone death. I think we would have ended her life more quickly or simply made her more miserable with aggressive chemotherapy.
I didn't "let her die." She was going to die soon no matter what we did. I was trained for many years to know that. I believed comfort was more important.
If we as a nation (the USA) want "everything done" for everybody, we will all have to pay much more in taxes - which is OK with me.
I would prefer to do everything possible, and I need very little money for myself. Even with unlimited resources, subjecting some people to aggressive chemotherapy is wrong medically and rationally. "Primum non nocere."