Monday, February 6, 2012

Cost Of Dying In America

The cost of dying in the United States is exorbitant and is bankrupting the nation. We doctors have had all too much experience with this unstoppable spending of other people's money. We have witnessed the endless laboratory exams, the daily radiologic imaging, the dripping of thousands of dollars of drugs into the veins of patients in futile attempts at playing God. Fifty percent of Medicare spending goes towards only five percent of the population. The last one year of life causes twenty-five percent of the federal program's spending. Yet this expenditure goes on every day in every hospital from coast to coast.

While hard monetary numbers can be difficult to come by, a writer's experience with the last days of her father's inpatient care at Stanford Hospital provides a rare glimpse into the actual dollars and cents of watching a loved one die. Lisa Krieger had the unfortunate circumstance of watching her Alzheimer-ridden father, Kenneth Krieger, pass away in typical American fashion, in a hospital, hooked up to thousands of dollars worth of drugs and tubes, all for the faint hope of living one more day. It was not like Mr. Krieger wanted to die in this fashion. He had even explicitly filled out "do not resuscitate" orders so that he wouldn't die an unnatural death, a body kept alive by machines and drugs.

Unfortunately for Mr. Krieger, his dementia becomes progressively worse. One day he was rushed emergently to the emergency room at Stanford for necrotizing fasciitis. Despite his previous requests, the writer and her family decided to proceed with every medical treatment that other people's money can buy. Daily blood work were drawn. Exotic and expensive medications were given. All kinds of fancy consultants were called in. However he was not improving. Even more radical treatments were contemplated, including surgery on an octogenarian with little hope of leaving the hospital and living a productive life. Despite thousands of dollars of care, the inevitability of his death finally sunk in. Mr. Krieger finally passed away with pain killers in a private room, spending ten days at Stanford that resulted in a bill of $323,658. Medicare paid $67,800 of that bill with Stanford eating the rest, or more appropriately, passing the cost to the rest of us with private insurance.

All too many of us have seen that once a patient is unable to make his own decisions, his prior requests are frequently ignored by his family with the best of intentions. Doctors are too lame to tell the straight truth to family members. We hedge our prognoses with terms like "small possibility of" and "there's a small chance" even though in our hearts we know the likelihood of a patient surviving his hospital stay is practically nil. Every body has heard the miracle story where a patient lived years beyond what their doctors predicted and the doctors end up looking like cynical baboons. In a difficult decision like end of life care, families are looking for guidance, and doctors are unable or unwilling to give it. Therefore the family's only choice really is to continue aggressive treatment. This lack of leadership on our part has contributed to the health care crisis we are facing today.

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