Tuesday, August 11, 2009

Take a Pain Pill

Hospice Blog has an excellent post today about President Obama use of the term "end-of-life care." 

The Hospice Guy has noticed that Obama uses end-of-life care to refer to the elderly simply seeking healthcare, instead of differentiating between people who are actually in their last days, needing care that will take them through to their death. And in so doing, he worries that Obama is confusing the intent of hospice as a place where people can go to die in peace and as much comfort as possible once they have CHOSEN to die. 

As the Hospice Blog points out, Obama's use of the term is almost a window into how little he really knows about the day-to-day realities of the medical world. And whether you're for or against public healthcare, it's a little scary to think of anything but the utmost experts revising our healthcare system. Here's the video he shares.

(Please note: the title of this YouTube film is misleading. Obama is, of course, not that dismissive to the woman.) 

The woman asked if her mother, at 99, could have had a pacemaker under public healthcare, even though she was old because she had much higher than normal quality of life. I think the bigger question she was getting at was, what if it looks bad on paper, but when you see the patient in person, you can understand where a procedure makes sense—hence the reason she says, "A picture is worth a thousand words." And Obama's answer is disappointingly to infer that the surgery was not going to help (even though it did) and to tell her mother to take a pain pill!? 

He's telling her, no, right? I've watched this about five times trying to get through the political speak, but that's what's happening here, I think. He's saying, no, in essence, that the bigger concern is trimming the waste from the healthcare system and her individual mother matters less? Other interpretations? 

I love that people are discussing healthcare in such a high-profile way right now—especially when it comes to end-of-life matters like resource allocation in the last years, what constitutes quality of life that is good enough, etc. But I hate that the discussion is being handled with such vitriol. And I hate even more that a bunch of politicians, mostly constitutional lawyers, with voters and elections on their minds are going to decide how healthcare issues should be managed. 

I hope the legislators are consulting some good healthcare professionals behind the scenes. 


Anonymous said...

I agree, Palliative Care experts should be consulted in these matters. It's a hard pill to swallow if you tell someone that their 99 y/o Mother should not have a pacemaker. In Palliative Care, in every situation we always say "It Depends." We never tell a family that their loved one doesn't have quality of life since it is not for us to determine this. I just think Palliative Care discussions need to happen with patients and families instead of absolute rules. For example, does the 99 y/o mother continue to be active, is she playing bridge, is she lucid, would she want her life prolonged in this situation or does she have severe COPD, CHF, advanced dementia (with the inability to make her own decisions now) and has stated several times in the past to her family that she wouldn't want her life prolonged under these circumstances. These kinds of discussions with patients and families are paramount and only after having these discussions can appropriate (for the patient/family) decisions be made.

Jessica Knapp said...

Absolutely! Thanks for the comment, Hospice Physician. I just hope, whatever reform comes about, we all end up with a greater ability to decide for ourselves instead of a lesser ability.

And if the media attention can give people more comfortability talking about death and dying, so much the better! But I'm not holding my breath on that one, since every time I see a healthcare discussion on TV these days, it's all yelling and finger-pointing, and Republican vs. Democrat talking points. Oh, I do not like politics.