Why it is the way it is.

Recently I wrote about Joe Klein’s cover story in this week’s TIME magazine, chronicling the recent death of his parents. He eloquently describes the process of losing loved ones and making decisions to help them die with dignity. One of his biggest frustrations was with the health care system – from the lack of candor from health professionals to a system that lacks coordination. His piece helped expose the fragmented nature of our health system from the perspective of a caregiver.

During any health crisis, caregivers rely on the expertise of doctors and the effectiveness of the system to guide a patient through appropriate medical care. So when the guidance isn’t clear, the care ineffective, caregivers and health-care decision-makers can rightfully become frustrated, confused, desperate, angry, and emotional.

So why does this happen? I believe it is a combination of things. First of all, doctors are trained to save lives. It’s their very purpose to fight for a life. They are warriors in battle against disease and death. Sometimes, health professionals don’t have the courage to say there is nothing more that can (or should) be done. It may be that they are struggling with the failure of not saving a patient. Sometimes, the family isn’t ready to hear the truth – that the end is near. Mr. Klein interviewed a doctor who admitted, “Sometimes the family members don’t (get it). Sometimes they want us to do all sorts of things that just aren’t realistic, and we have to be very patient about walking them through the reality of the situation.,” said Dr. Victoria Devan of the Geisinger Health System. Basically, doctors are human – and imperfect like the rest of us.

From there, the reasons get more complicated. Our health care system is based on a fee-for-service payment system. Doctors get paid to do procedures – everything from administering a flu shot to removing an appendix. They don’t necessarily get paid to make a patient comfortable or advise that nothing more should be done. The system inevitably rewards physicians financially for doing more tests, procedures, and treatments. That explains why Medicare will pay for an elderly woman to have a heart valve operation to fix a condition she has had since birth. According to The New York Times, up to one-third of the $2 trillion of annual U.S. health care expenditure is spent on unnecessary hospitalizations and tests, ineffective new drugs and medical devices, unproven treatments, and unnecessary end of life care.

We also live in a litigious society where medical malpractice costs are huge. According to a Congressional Budget Office Report, the total direct costs to healthcare professionals resulting from medical malpractice liability (including malpractice insurance, settlements, awards, and administrative costs not covered by insurance) was $35 billion in 2009. [1] With that level of expense, who can blame health care professionals for being cautious and ordering extra tests or treatments to make sure they are making the right recommendations?

I’m not suggesting that doctors are scoundrels trying to make a buck off every sick patient by ordering unneeded tests. But as savvy consumers of health care, we need to be aware of the realities of the health care system. Part of being an advocate for your or someone else’s health is having the ability to question the value of certain tests and procedures, especially if they are invasive.

Estimates vary on the cost of end of life care. One report said in 2009 Medicare spent $55 billion on doctors and hospitals bills during the last two months of patients’ lives. That’s more than the budget for the Dept. of Homeland Security or the Department of Education. It’s estimated at 20 percent to 30 percent of the medical expenses had no meaningful impact. [2]

Realizing and accepting that the end is near is part of the circle of life. It’s a difficult stage that we will all face at some point. My only hope is that the health care system won’t make it harder on me and my loved ones when our time comes.


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