Why there will be no medicare money left for your kids/grandkids really.

[annmariern]

Hi All.

Just an observation at work this past week and I am wondering how widespread this actually is. I work ortho, my patients are usually elective, also fractures etc. This past week I found myself with the very frail/elderly population, my fave group actually but what is happening to them has appalled me. Two in particular. One a 93 year old in fairly good shape considering an old cva. Living at home with his wife, developed a compression fracture, severe pain etc. Perfectly orientated on admit. So they want to do a kyphoplasty. Quick, 95% effctive at relieving symptoms, very cost effective. But, they put a foley in on admit ????no real reason, UTI and positive blood cultures. So now, they call in Infectious disease...mass IV antibiotics, a cardiologist for clearance, echo done EF 63%, big whoop. Then apart from the Interventional radiologist a neurosugeon. Meanwhile, he is bedbound, getting confused, agitated, can't see his wife (hard to get transport in for her), weaker by the day, execerbating his dyphagia and now he is aspirating. Speech eval for swallow study. Oh and the cardiologist wants a trans-esopheal echo. 4 docs. Now they order a TLSO brace $400 that will gather dust because he is too confused to co-operate with PT to ambulate etc. Going slowly down the tubes. Next one a 78 year old nursing home patient, dementia, multiple medical probs. Encephalopathy. Total care. Internal medicine, ENT, Infectious disease, Cardiology, Renal, psych. and the cardiothoracic because of a absent pulses on rt leg, audible on doppler, no pain, discoloration, ulcers, nothing. He sends her for an angiogram which showed partial occlusions. So today he comes in, whips the covers back to reveal a pink, warm leg and states, "thats obviously ischemic".I worked vascular for 5 years and know what an ischemic limb looks like.

Fem pop bypass ordered for tommorow. He asks her if she wanted surgery, she has no clue what zipcode shes in. So he calls (or rather I have to call) the nephew, POA, whose working, on the road and he tell him she needs it or she will lose her leg. At minimal risk for surgery. So thats that, shes going. Just adding up the expense of one hospital stays tests, each one abnormal (hello these people are OLD, of course there will be no perfection. Each test result leading to a new consult, new tests, it never ends. Meanwhile these patients are getting worse by the minute, each drug, each surgery complicating every thing. It is insane. These helpless people being subjected to being put through this crap for what? Quality of life? Or a medicare lottery win for the doctors, hospitals, labs, etc? I absolutely am sure neither of these people will live the year out, and that last years will be spent in a hsopital or nursing home bed. Miserable and pointless. I saw this whole thing repeated enmasse all week to varying degrees of stupidity. So when I see on the news how medicare is running out of money because there are simply dealing with the againg population it makes me sick. It isn't the numbers, its the milking of the system and profit. I don't for a minute believe because your old, you should be denied treatment. But when the treatment is beneficial, worthwhile and to aid quality of life. Is it just me or does anyone else feel like they are part of a healthcare system that isn't about real medicine anymore, just profit and loss?

[JeanettePNP, MSN, RN, NP]

I just read a great book over the weekend that would be right up your alley. Help or Hype, by Dr. Richard Devo and Donald Patrick.

[ceecel.dee, MSN, RN]

I appreciate your post, and agree.

What makes me even madder, are the expensive tests ordered without thinking "what will you do with the results" in many of the elderly who largely wouldn't even follow up on a positive result.

This is an age of cover-your-a$$ medicine, and doc's are forced to practice this way (combat the sue-happy), encouraged to practice this way (run up those charges and we'll reward you) rather than really contemplate the effects on their patients. Now, I am not a great defender of doctors (at all), but this can be a tough spot to be in. Patient's play a big role in this too.

[LHJ_RN]

Oh yes! Last year I can recall one old gal, 93, bad CAD had an MI. Was doing ok, and the docs tried to talk her into CABG. She says no and just wants to go home on meds. YAY! Well a month later, her family decides that she should have the surgery, talk her into it, and we are now doing CABG x 4 on a 93 yr old lady who spent a month in the hosp and ended up going to ECF on d/c. Yeah, we really did her a favor! She isn't the only one that ended up like this! Makes me angry.

[VivaLasViejas, ASN, RN]

I warned my family long ago that if they ever put me through this sort of thing when I'm old and my body is worn out, I'll haunt them forever after I finally pass on. Not only do I not want to be an unnecessary burden and expense, I just have this thing about dignity........and being attached to a bunch of wires and tubes, lying in my own dirt, and having to be turned every 2 hours doesn't fit my concept of it.:stone