Medicine: Have we gone too far? And, is our system ethical as a whole? - page 6
Sometimes I disagree with some of the things that I do in my job. I'm sure we've all felt this, such as a 95 year old full code on a vent, or other such scenarios. Personally, I feel like... Read More
Feb 7, '07Occupation: CRNA Specialty: 45 year(s) of experience ; From: MI, US ; Joined: Nov '03; Posts: 1,688; Likes: 2,217Quote from fourthmlThe point seems to be just because we can do something to save someone doesn't mean we always should.
Could we put a little thought into it?
The highest medical costs are now in the last 3 weeks of life in many cases. We do a lousy job explaining outcomes of illness to people. Plus people have come to believe there is a 'fix' for everything!
Hey don't tell me. Write a letter to the editor of your local newspaper. Nursing could use the PR and the public could use the education. This is a huge issue with lots of political ramifications. Get your letter in the AARP magazine - they have a huge PAC in Washington.
Mar 1, '07Joined: Jan '07; Posts: 15; Likes: 8As a psych nurse-I have to remind myself that ETOH abuse is still a disease and that we, as humans, have been given the gift of opposable thumbs and creative brains to reason on how to cure diseases of poor choices (and arguably genetics). I agree that we need to educate the puiblic on making death dignified-even for substance abusers. What I think the medical profession should rally on is not the amount of drugs that we CAN use, but when insurance tells us there are drugs we CANNOT use. Why should some desk jocky somewhere in a high-rise building tell any of our patients what a doctor can or cannot prescribe or how a client can take medication while hospitalized but be denied after discharge. The medical system is beyond flawed when Medicaid will pay for a 680.00 a day acute stay but won't pay 100.00 a month for medications. maybe some of the hard-on-there-luck citizens would be able to get off the juice to begin with if healthcare systems supported life. Then we could truly evaluate if we have gone too far.
Mar 1, '07Occupation: Graduate Registered Nurse Specialty: acute medical ; Joined: Oct '06; Posts: 172; Likes: 13Where I work, our hospital is commencing an initiative called "Respecting Patients Wishes" (I think that is what the title is). As I understand it, there is education provided for all staff and I think patients are asked at the beginning what sort of care they receive, and thats not just relating to death. But do you think I have seen it in action? Apparently they are using it in alot of southern Australian hospitals with good results.
It would be good to use something like this because:
1. patients would have some education and obviously some choice.
2. nurses wouldn't have to "jump" on everyone who doesn't have a do not resuscitate order.
Ah well, one can only dream of practical policies
Mar 4, '07Occupation: RN Joined: Nov '99; Posts: 2,950; Likes: 619Quote from childpsychnurseAMEN!The medical system is beyond flawed when Medicaid will pay for a 680.00 a day acute stay but won't pay 100.00 a month for medications. maybe some of the hard-on-there-luck citizens would be able to get off the juice to begin with if healthcare systems supported life. Then we could truly evaluate if we have gone too far.
Mar 18, '07Joined: Sep '05; Posts: 937; Likes: 136[QUOTE=GardenDove;202643spends on these heroic attempts to reverse the irreversable.[/QUOTE]
or to delay the inevitable.......................
perhaps it could be one of those "mandatory" things on the docs check off list as we get older- seems every yr another simple preventative test goes on ( or every few yrs - you know - paps - then mammograms then this test and that as we get older) -
i dont think the suggestion ( dont recall who made it ) though it was a nice thought - i dont think it shoudl be mandatory to graduate high school - its not like cpr that doesnt need much comprehension of life- like my dad half jokingly said as he made me executor - " now dont just go pull the plug because LOL" - twas all in fun for my teens benefits as they are uncomfortable talking of death and happened to be there and were no9t happy about the conversation - but what really do teens and younger adults know or can even fathom of things lke this other than they are untouchable lol.
however as we mature and get older if it were added - i dont even know what age - 30 maybe ( lol for my dear hubby itd be 80 lol) once a person has had time to appreciate life and consider things beyond today and tomorrow. ( or sooner if one gets ill of course) i dont knnow the solution - just a thought from my end.,Last edit by twotrees2 on Mar 18, '07 : Reason: add a suggestion
Mar 18, '07Occupation: Medical Imaging RN~Special Procedures CT Specialty: 33 year(s) of experience in OB, M/S, HH, Medical Imaging RN ; Joined: Aug '04; Posts: 6,708; Likes: 1,449Quote from GardenDoveI agree and that is so very sad. I think devoutly religious people who are afraid to die and not truely "religious", they walk the walk and talk the talk but when it comes right down to it if you truely love and trust God you won't be afraid to die. I'm not saying you wouldn't be upset if you found out you had terminal cancer. I'm saying when the time comes you wouldn't fight it because you know you're going to God. JMO.The reason, though, that people don't address it is fear. People are afraid of death, pure and simple. Even devout religious people are.
Mar 18, '07Joined: Sep '05; Posts: 937; Likes: 136Quote from GardenDovei am sure every state is different - but here in wisconsin there is no such thing as a generous welfare system - used to be 20 yrs ago - thank god or id never had made it through school raising my 2 wee ones plus my alcohlic brothers 2 wee ones ( same ages as mine so like 2 sets of twins eeks lol) -There are, actually, some people who are permanantly dependent on public assistance, and do know the system inside and out. You can't project your own middle class standards on everyone and assume that everyone shares your desire to contribute and be productive. Yes, sadly, a certain segment of the population is not able to function within the framework of modern society and will seek to exploit the generosity of the social welfare system.
its work for welfare- you work they pay you - they tell you where to work - you cant just get money anymore - and the rest of the programs also are very stringint - i know its cause wisconsin had a very ( at least in my area) high rate of abusing the system long ago - its unfortunate- i know many a single mom with several kids lefyt behind by deadbeats who are stuck in dead end jobs cause they cant go to school and work at the same time ( and before im blasted by " yes they can i did it yada yada " please dont bother- not everyone is capable of doing so - i know i would never have made it thorugh nursing school had i had to work and go to school both full time - nope wqouldnt have happened - ) the gals i now would bust butt to get a degree and be able to get off as soon as tey coul and support thier fmailies better - however now they beg for whatever they can get cause the best they can get is a mcdonalds job...... that to me is sad - that there really was ( and i am sure still is - ) rampant abuse of the system making it bad for thise who would use it for good.
Mar 18, '07Joined: Sep '05; Posts: 937; Likes: 136Quote from Agnusmy own view- faith wise i do not fear death - its leaving the ones i love behoind - afraid of what will happen to them if i do die ( like my kids- what would hppen if they were stuck with my alcoholic, emotionally disturbed husband ) before situations are stable for them that if im not here they owuld be ok.Interesting. I had someone ask me last week. "If we believe we will go to heaven, why do we fear death?"
It is of course within every living organism the inate "need" and there fore struggle to survive. Reproduction is linked to this survival response.
Mar 18, '07Joined: Sep '05; Posts: 937; Likes: 136Quote from psalm_55even when they do have ins its rediculous - my son had 2 doc office visits - his total out of pocket wsa over 200 for thise 2 visits and a xray- they wanted to d0o an MRI- his total out of pocket would bbe over 1000 - i finally got through to him to go through the VA where it will be totally covered as its due to 3 tours in iraq - it just surprised me as my hubby used to work at this place and they had great ins- i was bowled over by the change.ACCESS to health care is unethical.
i believe the USA is the only industrialized nation without universal access to health care.
many of us have children who are 23 y.o. and kicked off the insuramce role. they/we must forage for affordable health insurance coverage and self-pay.
if they are without insurance and need an expensive diagnostic test such as an mri, it's cash up front -- or no mri. and the average ER visit is about a thousand dollars.
at the other end of the spectrum -- look how many 70 and 80 year olds (and older)are on cholesterol-lowering drugs. WHY???
given the cost (which is being transferred to taxpayers now) and the age, haven't these drugs ALREADY done what was intended?
they lower cholesterol in order to prevent a cardiovascular event. their effectiveness is measured in DECADES. so, one who starts on these drugs will see the actual intended effect about 10 years down the road.
i don't get it.
Mar 18, '07Joined: Sep '05; Posts: 937; Likes: 136Quote from nursemikehaving had numerous eoropean students at our house as exchange students - theyall thought our health care sucked- they have healthcare for everyone- however they also pay MORE THAN 50% of thier income in taxes- can you see americans willing to give that much in taxes to add healhcare of everyone- most of us complain about the taxes we do have to pay al.ready. i just dont see the consesus saying yes we will pay that much to have universal health care.Mandatory euthanasia at 40 y.o.--there's the solution!
Just recently googled the National Debt. It's just under 9 trillion dollars, or about 28000 for every man, woman, and child in the US. That's a lot, but...we aren't wasting trillions at a time in Iraq, on healthcare, or anywhere else. The billions do add up, but a trillion is still a lot of money.
A big part of where baby-boomers squandered our national treasure was on educating our children. Also highways, healthcare, and defense. A lot has been wasted, but a lot has benefitted everyone alive today, including the children and grandchildren of the boomers. The reality is, we all expect a certain level of service, and we have to pay for it either through taxes or deficits. There are still too many people who think the government should pay for its various programs, rather than the taxpayers.
As far as healthcare goes, I still think we probably spend more on 4x4s than on heart transplants. I think we'd see fewer full codes if we did a better job of educating people about advanced directives. I think we'd see fewer dubious ER visits if people had better access to primary care. I don't think we'll see much progress on the latter until we have a national health insurance program, but I'm sure I'll groan as much as anybody when I start seeing the premiums coming out of my paycheck. Still, universal health coverage ought to greatly reduce the need to draw money out of the general budget for Medicaid, and that money could then be used to help reduce the deficit.
It's a proven fact that we can run the country without deficits. It does require some sacrifice to do so, and, unfortunately, a significant part of that sacrifice will have to be in the form of higher taxes (interpreting premiums on universal health care as, essentially, a tax).
Mar 21, '07Occupation: CRNA Specialty: 45 year(s) of experience ; From: MI, US ; Joined: Nov '03; Posts: 1,688; Likes: 2,217Quote from twotrees2That's the business of life that you have to take care of NOW because you could not be here tomorrow. I once had a young female patient on chemo who knew she wasn't going to make it but she had to stay alive long enough to make arrangements so keep her kids out of her husband's house. You see so many patients on chemo that are just lining someone's pocket, but I'll never forget her because she really needed to live long enough to get this finished and suffering the toxicities was well worth it. Good luck to you and your children.my own view- faith wise i do not fear death - its leaving the ones i love behoind - afraid of what will happen to them if i do die ( like my kids- what would hppen if they were stuck with my alcoholic, emotionally disturbed husband ) before situations are stable for them that if im not here they owuld be ok.
Mar 21, '07Joined: Sep '05; Posts: 937; Likes: 136Quote from subeethanks not that hubby is " bad" hes sick - i do lov him dearly and he isnt to bad a dad ( though he doesnt work he does fair being stay at home dad ) adn he hsant been able to drink with no job as i wont give him money - - so maybe if i cant win the lottery to set them well off maybe i could find them a new wife / mom LOLOL> god blessThat's the business of life that you have to take care of NOW because you could not be here tomorrow. I once had a young female patient on chemo who knew she wasn't going to make it but she had to stay alive long enough to make arrangements so keep her kids out of her husband's house. You see so many patients on chemo that are just lining someone's pocket, but I'll never forget her because she really needed to live long enough to get this finished and suffering the toxicities was well worth it. Good luck to you and your children.
Mar 21, '07Joined: Mar '07; Posts: 20; Likes: 1The long term acute care facility I work at weans people off vents that are more difficult than most to wean, if/when we deem a patient unweanable we inform families of other options ie: compassionate weans/terminal weans. In my state however, medicaid will not allow us to terminally wean their recipients, instead, we must pay for an ambulance service to send the patient to a long term care facility so that they may carry out their compassionate weans....the government would rather spend more money in transporting these patients to other facilities so they can "save" money...hehe, generally these patients are over 90 years old...cracks me up!