Published by: Lynne GO on 4/7/2010 3:43:34 PM
I read an interesting article in today’s New York Times business section titled, “In Medicine, The Power of No” about curbing costs in our health care system by creating a culture of patient education and awareness and that "less may be more" where health care is concerned. It talked about the many health reform provisions, like the comparative effectiveness center, whose purpose is to “say no” to health care treatments, or at least provide data and information about the relative benefits of one type of care over another with the goal of reversing the system’s incentives to provide more, newer, higher intensity care. The main thrust of the article is that just saying no may cause trouble with the American public– citing the unpopularity of managed care as an example–but empowering people by educating them with more information about options is aligned with autonomy and self-determination, both popular American values.
While innovation and comparative effectiveness centers will provide information, educating patients is something that health care providers have the responsibility to do. Yet this same notion is what caused so much vitriol about “death panels” last summer. The simple idea that physicians and other health care providers should be paid to counsel patients about choices for end-of-life care was used to inflame the American public. In a calmer climate post health reform (if we are in that climate), it seems like this discussion needs to be had.
If you’ve ever had a parent or grandparent in an ICU at the end of life or getting heroic treatments when there really is no hope of recovery or improved quality of life, you know how heart-breaking and unpleasant, if not downright cruel, those situations are. If health care providers could have clearer and more direct conversations with patients and their families, the option for less care may be the preferred option more often than not. Safety net hospitals have increasingly adopted palliative care programs because they are the right thing to do for the patient, first and foremost, and just happen to save money. We have responsibilities in the health care community to lead the effort to have these conversations, not just because they will save money, but because they are the more humane way to care for people.
So, what do you think?