You are obviously not a physician...and that’s not a dig, just a statement.
Medicare and Medicaid patients have little to no cost share in therir care, for themselves or their families. Why is that important?
Because I’ve seen 90+ yo , long-standing NH pts who are severely
demented to the point they do not know who or where they are having all sorts of tests and studies ‘at the families’ request to keep the relative alive, at all costs, because the cost to THEM is negligible if any, other than the effect on their conscience. It isn’t up to the Doctor (thank god) to determine who deserves care
Neither should it be the Government...who pays based off satisfaction surveys and the like.
If your the on call in-house Doc and grandma is circling the drain...and you call DPOA who says do ‘everything ‘, it’s not like you have a choice. Do it and you get criticized, don’t do it and you get sued.
Great system, no?
“Because I’ve seen 90+ yo , long-standing NH pts who are severely
demented to the point they do not know who or where they are having all sorts of tests and studies ‘at the families’ request to keep the relative alive, at all costs, because the cost to THEM is negligible if any, other than the effect on their conscience.”
The flip side of this though, is the smaller community hospitals where we have taken our 90 year old, brain-injured, disabled mother. If there is a respiratory infection, mild flu, UTI, etc. they insist she must be admitted (against our wishes) and then they proceed to do every test and procedure they can get away with and try to keep her in the hospital as long as possible. We have been taking care of her for 27 years and know how to do it, except occasionally she gets sick and needs an antibiotic. Physicians don’t want to treat these things in their office anymore or one cannot get an appointment for days for an acute illness and they tell you to go to the ER. They literally take your patient captive- the hospitalist, that is. This is a very bad system. The hospital “best practices” require all this extra testing and treatment. The hospitalist changes all their medications and add more and then want them to see a specialist for 90 year old aging body issues.
In my neck of the woods we have had the opposite experience. Doctors have always recommended the least amount of testing/care/treatment/meds when it comes to our very elderly family members. Usually that’s been appropriate. When it hasn’t, we’ve argued for and gotten additional care for our loved one. But we have never had anyone order/recommend anything unnecessary.
I understand that. We have disconnected cost from consumer. Hospitals and doctors charge monopoly money. Because they can. Patients over indulge in health services because they are disconnected from cost. Health care providers charge monopoly money for the same reason. Usless and expensive prescriptions that are lifetime drugs. How am I almost 50, my parents are 80, my wife is mid 40’s my kids are young adults and we are on zero meds? None. My brother and his family are similar in age and make up. No drugs. How is this possible? It’s a choice. None of us has seen a health care provider except for injuries in 25 years. We are healthy because of that. But we are responsible for living in a way that makes this possible.