Can we really afford any more medical advances?

Nurses General Nursing

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Medicine has come up with more wonder drugs, procedures, technologies than ever before. All of it very expensive, too. It all comes at a big price. It's becoming more and more difficult to deliver it to everyone.

Have we gone as far as we really can practically manage, without going broke? More and more can be done, but will it end up bankrupting us? Obama is talking a lot on controlling Medicare costs before it goes bankrupt.

There's a lot of talk of how socialized medicine, universal coverage, is our salvation. But, is it really? I seriously doubt it.

How much does one MRI machine cost? Astronomical. Think of all the other expensive machinery in the hospital. And, at what cost is the regulatory burden? Then add in all the other costs. After that, figure in a bunch of heroic new surgeries and treatments. How about surgery on babies in the womb? Genetic manipulation, cloning body parts, new expensive treatments for AIDS patients with drug regimes totaling in the tens of thousands a year. Then add on all the new dialysis patients expected in the wake of our obesity/diabetes epidemic.

I don't think we can afford much more of this.

Specializes in ICU/Critical Care.
We have to stop keeping the living dead alive. Three strokes, no mentation, and INR's thrice weekly, blood thinners, anti-seizure meds, beta-blockers, yada yada yada - when do we let people go?

I have to agree. I don't think this happens in other countries as much as it does here in the States. I took care of a 95 yo man whose 65 yo daughter was his DPOA. That man ended up with a peg-tube, trach, vented and with decubs. I thought it was horrifying and I was even more sick to my stomach when she yelled at her dad for "five more years". I would NEVER do that to my parents. It's no quality of life but she wanted to continue on. I took care of that patient when I worked on a stepdown unit and we had many patients like him. Now I work in ICU and the docs are more proactive about explaining what is going on with the patient, the injuries, what they mean, the tests. I've only had one patient that couldn't be declared brain dead but was unresponsive, trached and vented. Docs tried their best to convince the family that nothing more could be done. The patient was 30yo and coded while in labor. The docs did an emergency c-section while she was coded. She was down for 15 minutes. She ended up going to a ECF where she died a month later.

Specializes in LTC, Med/Surg, Peds, ICU, Tele.

Thanks for that excellent video. Jack LaLanne is such a role model and guru. I totally agree with him!!! I remember watching him back in the 60s when I was a kid.

llg makes very important points about education, I so agree!

Specializes in LTC, Med/Surg, Peds, ICU, Tele.
actually pasteur invented his procedure for wine, it damages milk......besides milk is not a natural food for an animal other than the intended species....or beyond toddlerhood.....

and yes...some of these procedures that were developed more with younger healthier trauma patients in mind do not need to be applied to the over 80, comatose patient.....

Show me a Hamburger Helper Dinner that does not use milk and do you really think I am going to go in the back yard to milk a cow to get that milk.(My milk supply dried up a long time ago.) I take much pleasure in knowing that my milk has been pasturized and is safe to drink and I can buy it at the store. Read the post on the Athelon product that is in use in India for filtering out viral diseases such as HIV, Hep C and some tumour producing toxins. They mention that the failure of their product is based largely on financial risks, lack of funds for government testing and approval not to mention to supply the amount of devices that will be required.

Specializes in Medical.

you might be interested in reading ehticist daniel callahan's trilogy of books ( setting limits, what kind of life, and the troubled dream of life), in which he explores the impact of technology on health care, popular expectations of what constituted 'standard' or 'ordinary' (vs extraordinary) treatment, and the economy. in doing so he

set an innovative agenda for biomedical ethics. that agenda requires us to first ask what the goals and purposes of medicine should be: the prolongation of life at all costs by technology? the defeat of illness and the slowing of aging in a war against death?

callahan instead proposed that medicine be devoted to caring, including the relief of pain and suffering, rather than curing all afflictions of the human condition. the primacy of caring requires that social priorities and limits be set on the use of health care resources and that the culture support in attitude and practice an idea of a "peaceful death." to accomplish this, callahan asks society to draw upon the moral traditions of caring communities rather than the [color=#003399]adversarial claims of individual rights. he applied these concepts to the subject of old-age in a world growing old: the coming health care challenges (1995) which is based on the results of a worldwide research project dealing with medical care for the elderly.

callahan's writing is lucid, engaging and somewhat confronting if you come from a 'treat at all costs' mindset. he's often accused of being ageist, and of advocating involuntary euthansia, but my reading of his work is that he's interested in reversing the trend of most health care dollars being spent on the sickest, oldest patients in their last year of life.

Maybe if we invest in prevention and health promotion we will not have the need to use so many of our fancy medical advances. It costs a lot less to prevent chronic disease than to manage it. Along these lines...

1) Teach people how to access levels of healthcare and penalize them for doing so inappropriately

2) Teach at-home disease and symptom management

3) Provide incentives for people living a healthy lifestyle or taking steps to manage their chronic disease. Do not penalize.

4) Utilize evidence-based public health interventions for prevention of HIV, STD's and teen pregnancy

4) Reward providers who correctly follow guidelines for chronic disease management and prevention of complications

5) Reimburse based on better patient outcomes vs. number of procedures/diagnoses

6) Fix health insurance. Cover people with pre-existing conditions so they can manage their disease and don't end up on the taxpayer's dime in the ER. Create a level of insurance that is affordable and basic. Make this insurance mandatory like car insurance - so people can afford to access primary care and be screened for cancers and chronic disease before they are sick.

Our healthcare system is at a point to where it is unsustainable. Health policy research has been done on these issues. We know what to do, we just have to do it.

Specializes in Gerontological, cardiac, med-surg, peds.

Moderator's friendly note: Please keep to the subject at hand to avoid derailing the thread. If a comment upsets you, please report it to the moderating team rather than responding to it in the thread.

Thank you :) Carry on! Great discussion :)

Specializes in LTC, Med/Surg, Peds, ICU, Tele.

One fact is that prevention, though important, only delays the inevitable end of life decisions. Eventually even Jack LaLanne will be on death's door.

You might be interested in reading ehticist Daniel Callahan's trilogy of books ( Setting Limits, What Kind of Life, and The Troubled Dream of Life), in which he explores the impact of technology on health care, popular expectations of what constituted 'standard' or 'ordinary' (vs extraordinary) treatment, and the economy.

I can't find him on Amazon.

:(

Specializes in LTC, Med/Surg, Peds, ICU, Tele.

excellent essay Sue! That sums up my original premise for this thread quite well!

Specializes in Medical.

Daniel Callahan on Amazon: http://www.amazon.com/exec/obidos/search-handle-url/ref=ntt_athr_dp_sr_1?%5Fencoding=UTF8&search-type=ss&index=books&field-author=Daniel%20Callahan - though there are a lot of 'what the?" hits, the top few are all him :)

The full titles of the trilogy are Setting Limits: Medical Goals in an Aging Society, What Kind of Life: The Limits of Medical Progress and The Troubled Dream of Life: In Search of a Peaceful Death.

I'm not sure if Vicky's moderator note was directed at me but in any case I want to be clear that my "if you come from a 'treat at all costs' mindset" comment was meant to be informative about his tone and was not directed at anyone.

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