Comments on GeriPal - Geriatrics and Palliative Care Blog: The Cause of My Life: Ted Kennedy’s Healthcare Leg...

Some of the above comments make me think of the ch...

2009-08-28T20:11:01.827-07:00

Some of the above comments make me think of the challenge of not bringing in our personal opinions into the palliative care consult.

While I too feel that our society expends exorbitant resources to no avail as people are dying. I never want that opinion to change the way I see patients. I want to be a values neutral advocate for people's wishes - even if that means they wish to die ventilated in the ICU with a back-up ventilator at the bedside.

We shouldn't use the phrase "high end-of-life costs" or "wasted expenses" but rather, we should talk about "unwanted expenses" That is, when patients are truly informed and not making decisions based on naive preferences, they often choose the less aggressive option. Thus, good patient-centered palliative care can often (but not always) avoid "unwanted expenses" near the end-of-life.

Chrissy, when I worked as a hospice case manager i...

2009-08-27T21:14:13.641-07:00

Chrissy, when I worked as a hospice case manager in Marin county, our hospice cared for many celebrities. I can't speak to why they chose not to make their choices public. And, of course, the hospice holds that information confidential.

Ah! Awesome, Alex, thanks for that piece of info!...

2009-08-27T16:27:54.676-07:00

Ah!
Awesome, Alex, thanks for that piece of info!
-Chrissy Kistler

I have been wondering about a few things: 1. Why...

2009-08-27T16:27:10.846-07:00

I have been wondering about a few things:

1. Why don't I know more about celebrities who choose hospice? (I know that, like Helen Kao said, we're not good spokespeople, but you'd think there might be a celebrity or family member of a celebrity who would praise hospice now and again). With Farrah Fawcett's recent death, and Patrick Swayze "fighting for his life", and now Ted Kennedy, I wondered: did someone mention hospice as an option? Did someone tell them that there was another way? It's just got me wondering.

2. I actually think wonder about whether it's okay for a patient to go to a hospital that is significantly inferior to another hospital. Oh, and I obviously allow that hospitals need a chance to improve. But we know that hospitals that do low volumes of procedure X, tend to do it worse. I have wondered if setting limits on choices might not be a good idea. Now, Leslie Kernisan's work shows that it's hard to figure out where are the "bad" and "good" hospitals, but Dartmouth and other places are working on this. How do we balance quality and choice

3. How do we get people to understand that more is not always better? Do we need MRI machines every block? Could we cut down on the unnecessary testing and administrative costs, and fund the uninsured? How do we get people comprehensive discussions about end-of-life planning and not another CT-scan? And, Anon, we could tax alcohol, tobacco, gasoline, sweetened beverages, if we really wanted to work at health care reform. Sweetened beverages are being considered for tax in NY, I think. I believe in social justice, and think that higher earners need to pay more to help those who make less, and if that includes my family, then so be it. I don't want to be someone who says they believe in equity out of one side of my mouth and then cry about taxes out of the other. I would state however that Hillary Clinton called for a public plan very similar to the Senate plan during her run for the White House. At least, that's my understanding.

They're just some thoughts that stew around in my head.

Nice comment on Sentator Kennedy's last weeks ...

2009-08-27T16:01:22.348-07:00

Nice comment on Sentator Kennedy's last weeks and months in the New York Times. He put his advance directives in order, and focused on comfort and being with family at the end.

I absolutely agree that it was good that he had th...

2009-08-27T14:40:05.423-07:00

I absolutely agree that it was good that he had the choices he did, and he was able to make them. Following your goals, is, as you say, the greatest thing we help folks do in our profession. I firmly disagree that those choices would remain if healthcare payment reform goes through. We will all have access, but that access will be limited by the finances, as currently proposed, whether we like it or not. There is not an unlimited pot of money for coverage for all these treatments for everyone. It just isn't there. Sen. Kennedy would have had his choices in either case simply because of his status and wealth. What bothers me most is that he wasn't really honest about what that might mean to those who would gain access to care.

I also recognize clearly that limited access is far superior to no (real) access. I am not opposed to payment reform. I just think we need to be clear about what it truly means to everyone, and also REQUIRE those in Congress to play by the same rules as the rest of us.

By the way, it is not health care reform at all, just payment reform. If we want health care reform, we go after the causes, i.e. smoking, obesity, sedentary lifestyles, etc.

Anonymous, I had a similar thought then I caught m...

2009-08-27T08:13:23.644-07:00

Anonymous, I had a similar thought then I caught myself - perhaps aggressive care was completely in line with his goals. What if Ted Kennedy told his physicians something like "I know my chances are slim but I want to give myself every chance to be around during the upcoming health care debate - I think we may finally be at a place where we could do something and I want to help."

Also, he did die at home which says something about his level of aggressiveness.

Interesting thoughts anonymous - I'm actually ...

2009-08-26T20:36:42.248-07:00

Interesting thoughts anonymous - I'm actually not bothered that senator Kennedy didn't choose hospice. For all I know he considered it and decided not to enroll. That's fine - he had the choice – and he would have had it with health care reform. There are many people who don’t have the choice because they can’t afford insurance.

Same thing goes for where he got his health care – he could have gone to a small hospital in Martha’s Vineyard, but he decided to go to places like Duke and Mass General instead. That's fine - he had the choice – and he would have had it with health care reform. There are many people who don’t have this choice because they can’t get insurance due to a pre-existing condition or can’t afford it because they lost their job or own their own small business.

Not having the choice is the part that bothers me and is the reason I'm for health care reform. What do others think?

Well said, Chrissy. I happened to be at the Kenne...

2009-08-26T19:38:54.702-07:00

Well said, Chrissy. I happened to be at the Kennedy Library the day Senator Kennedy was diagnosed. The TV cameras were there, and I was interviewed by the channel 5 in Boston, video here. As I said then, his legacy has been as a champion for health care reform, and his death may serve as a call to action for those of us, myself included, who have sat on the sidelines for too long.

Is anyone else bothered by the fact that, though h...

2009-08-26T18:58:33.807-07:00

Is anyone else bothered by the fact that, though he had a fatal disease, Sen. Kennedy chose to seek treatment at the "best money can buy" facilities? Had his version of health care payment reform been applied to himself, would he have been able to do this? I personally believe he missed a HUGE opportunity to show the value of advance care planning, palliative care and hospice, by taking advantage of those programs himself. Had he done so, I suspect we would be hearing a lot less about the factitious death panels trumped up by reform opponents.

I am not trying to besmudge the legacy of a great statesman. I believe the Kennedy family's mark on this country has been overall extremely positive. I grieve his loss, and pray for his family. I just wish he would have used his leadership to guide others with terminal illness to consider their options.

Beautifully put. Thank you for that inspiring remi...

2009-08-26T15:14:09.944-07:00

Beautifully put. Thank you for that inspiring reminder.