Friday, January 20, 2006

An End of Life Story

On the general subject of physician power, friend and former co-worker in the vineyards of hospital administration Peter Geilich provides the following:

My mother-in-law recently died after living more than 90 years. She has been in a nursing facility near us for two years and did quite well until 3 weeks before her death. Then she sort of 'fell off the table.' Her capable internist MD wanted to move her to the hospital and do brain scan and intensive Rx. Stupid. We fired him and brought in a palliative care MD (also an internist) who eased her down in a dignified manner and she died surrounded by people she knew and who cared about her. Therein lies some of the problem of high health costs and unnecessary Rx. I spoke about this with a doctor I knew well in another town - he said his protocol is to give the family a choice about intensity of care. Unfortunately, he says, many families choose intensive care and all that goes with it. He is stuck - afraid of being sued. So, the legal system is another factor - although in more than 150 expert witness cases I have never come across that sort of thing.

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