I’ve been busy today. So I didn’t have a chance to note two terrific posts over at the Incidental Economist (TIE).
In the first one, Austin Frakt gives a rather daunting assignment:
Listen to the Finding Emilie segment of the most recent Radiolab episode. It’s about a young woman’s near death and recovery after being hit by a truck. More than that, it’s about how her family participated in charting that recovery. How she was nearly left for dead, nearly sent to the nursing home for life, but, miraculously, is recovering. It’s an amazing story, the feeling of which can only be conveyed with the full audio-magic that the Radiolab team excels at.
After you listen, think about these questions:
o What would you do if the story was your own?
o Did Emilie receive too much health care? Not enough?
o Did her doctors work hard enough? Did they make the right decisions?
o If you were Emilie’s boyfriend or mother or doctor, would you have considered the cost of her care, how it was financed? If not, why not? If so, how would that have factored into your decision making?
o If, ultimately, decisions most of us make in health are from the heart, how do we navigate the system rationally? Should we?
o If you don’t think this is part of the crux of the health care cost issue, what is? Why do we love to spend so much? Are we thinking or feeling?
You should definitely read that, and then you should read Aaron Carroll’s response, drawing on a harrowing but all-too-typical experience many doctors have in their residencies. Here’s a snippet, but you should definitely read the whole thing:
Eventually, the ventilator stopped getting the job done, so we had to put the baby on an oscillator. Basically, instead of giving normal breaths, this machine shoves tiny amounts of air in and out really fast. It sometimes works when other things fail. It was loud, noisy, and made the baby shake. I don’t think he noticed.
Things slowly got worse. Nothing was working, and every vital sign was heading downwards. As instructed, I just kept adding stuff to keep him alive. But deep down inside, I started to think that what I was doing was wrong. Not incorrect — wrong….
I thought I would post a piece of Gawande’s article and talk about how we completely screw up end-of-life care. I thought I would make a comment about how we spend too much money or waste resources. I thought I would talk about tradeoffs and better choices. But I can’t. Partly because I can’t do his work justice, and partly because this is an issue where deep down inside I think we are doing a ton of harm. Full stop.
I would go further. We spend a lot of money on end-of-life care. Some of that money is surely wasted, beating the hell out of people when such heroic measures are no longer wise. Many health policy researchers, and others, note the high costs of end-of-life care and regard this as an arena we should engage to save money.
Let’s wait on that. Let’s first find out how to treat dying patients and their families honestly, humanely, and well. Once we’ve won people’s trust, we will have earned the right to start a second conversation, this one about lowering the costs of end-of-life care. Curbing health care costs is important, but so are other things, too. In this sensitive arena, it’s wise to be patient.
In the meanwhile, read Aaron and Austin today.