I have unfortunately spent quite a bit of time in the hospital over the last 4 years.
In all the hospitals I found the same short comings. They are sterile and cold, the food is not only sub par but not ideal for promoting healing. Ill stop there for now but I have found from personal experience that the above concerns can have a great impact on health.
My question is, is this all about the money? I just feel like patient care could be taken to new heights by incorporating some pretty basic things.
I know, I know, I am idealistic and ignorant to the reality of health care as a business but I would love to understand the in's and out's of the business side (I have a finance degree and see myself heading that way eventually)
What would you recommend as a resource to help understand for profit health care in the United States? I would like to learn about old issues that have plagued the system for a long time and new ones as well. I would really love to get an understanding of how the national health care act has effected hospitals as well; good or bad.
I would love to know who would be ideal to talk to in a hospital that could guide me.
I believe that we are obligated to educate patients and their families about expected outcomes of their chronic diseases whether or not they initiate the discussion. We also, as health professionals must address end of life issues and the notion of palliative care and hospice, again, regardless of whether or not the patient and/or family has initiated the discussion. It is our job to provide people with the information that they require to make informed decisions. Many of us have experienced the wrath of the family who does not want to hear that their loved one is dying. Many of us know that such wrath does not remove our obligation to provide them and the patient specifically with ALL of the facts surrounding their illness and the likelihood of recovery or death. For too long the medical field has preferred to sugar coat talk of death after waiting until the very last moment in care to discuss it. That practice is outdated, centered on the professional rather than on the needs of the patient, and is costing our health system millions of $$ in futile care.
Yes, there will be some folks who are "not ready" to hear about palliative care or hospice yet. But we mention it anyway and by the time we mention it AGAIN, some of them have changed their minds or are ready to hear more information. People don't always know what they need to know. Some of them are under the impression that they "have time" to make the choices about hospice when they really don't have much time at all and they are wasting their time and resources trying to keep living when all they are doing is trading their comfort and peace for a vague sense of "hope".
Sometimes hope is all they have.
i had a patient diagnosed with lung cancer, and five days after diagnosis, a doc mentioned likely outcomes. The patient said to me, "I haven't gotten used to my cancer, and he already told me I'll probably die. What about hope?"
I see so many of these conversations turn to palliative and hospice care with the excuse that they treat the whole person, saving them from side effects of the treatments that probably won't save their lives. Some people simply don't want to die, and they are willing to "suffer" to see another day. Younger (
Individuals have the right to make their own choice from among the treatent options presented to them, but there is no US law that requires hospitals or physicians to provide what they consider to be futile treatment -- individuals don't get to demand that hospitals and physicians provide treatment that the professionals don't feel is indicated.
And if professionals decide that when you come in with abdominal pain and you are diagnosed with stage IV pancreatic cancer, that they will not treat you, at all, do you think that is right?
Just to be clear my views in light of the last couple of posts. I advocated for my own sibling to be made hospice when she lost a lot of function after a sudden change. I advocated for her DNR. She was still talking, enjoying visitors, but was severely debilitated with stage IV + a sudden, unexplained neuro event. I am not afraid of hospice or palliative care, but there are some arguments here that frighten me a bit. Just looking at likelihood of survival with a diagnosis out of the gate and advocating for patients to not do anything. Just go home, have a beer and wait to die---but it will be so much "better" for you! (If I'm misinterpreting, please correct me.)
And if professionals decide that when you come in with abdominal pain and you are diagnosed with stage IV pancreatic cancer, that they will not treat you, at all, do you think that is right?
Just to be clear my views in light of the last couple of posts. I advocated for my own sibling to be made hospice when she lost a lot of function after a sudden change. I advocated for her DNR. She was still talking, enjoying visitors, but was severely debilitated with stage IV + a sudden, unexplained neuro event. I am not afraid of hospice or palliative care, but there are some arguments here that frighten me a bit. Just looking at likelihood of survival with a diagnosis out of the gate and advocating for patients to not do anything. Just go home, have a beer and wait to die---but it will be so much "better" for you! (If I'm misinterpreting, please correct me.)
I can't get behind that.
Define "not treat you at all" -- leave me to die in the parking lot?? Or provide me with "full service" palliative care? There are a lot of options out there. If I were suddenly diagnosed with advanced cancer, I hope I would be able to be realistic about my choices and chances.
Sure, there are lots of people out there who are "willing to 'suffer' to see another day" -- and they're willing to have society pay a small fortune to extend their lives for a short period of time, without in any way changing the outcome, and there are plenty of physicians and hospitals willing to (or afraid not to) indulge them. That's why we spend more money per capita than any other country on the planet (roughly twice as much per capita as the next most expensive healthcare system) and have lousy M&M statistics to show for it.
Define "not treat you at all" -- leave me to die in the parking lot?? Or provide me with "full service" palliative care? There are a lot of options out there. If I were suddenly diagnosed with advanced cancer, I hope I would be able to be realistic about my choices and chances.
Sure, there are lots of people out there who are "willing to 'suffer' to see another day" -- and they're willing to have society pay a small fortune to extend their lives for a short period of time, without in any way changing the outcome, and there are plenty of physicians and hospitals willing to (or afraid not to) indulge them. That's why we spend more money per capita than any other country on the planet (roughly twice as much per capita as the next most expensive healthcare system) and have lousy M&M statistics to show for it.
I guess I wasn't misinterpreting then. "Not treat you at all" would be defined in this case as symptom management rather than curative.
It's interesting your choice of words, though. "...I hope I would be able to be realistic...." Would you or would you not want a physician to "indulge" you?
Define "not treat you at all" -- leave me to die in the parking lot?? Or provide me with "full service" palliative care? There are a lot of options out there. If I were suddenly diagnosed with advanced cancer, I hope I would be able to be realistic about my choices and chances.
Sure, there are lots of people out there who are "willing to 'suffer' to see another day" -- and they're willing to have society pay a small fortune to extend their lives for a short period of time, without in any way changing the outcome, and there are plenty of physicians and hospitals willing to (or afraid not to) indulge them. That's why we spend more money per capita than any other country on the planet (roughly twice as much per capita as the next most expensive healthcare system) and have lousy M&M statistics to show for it.
If you feel this way, you have the right to make the decision to forgo curative care for yourself. Other people have their own values.
The fact that medical care is so expensive is not the fault of the patient.
As I posted earlier, the federal government cannot run out of money.
Specializes in NICU, PICU, Transport, L&D, Hospice.
Sometimes hope is all they have.
i had a patient diagnosed with lung cancer, and five days after diagnosis, a doc mentioned likely outcomes. The patient said to me, "I haven't gotten used to my cancer, and he already told me I'll probably die. What about hope?"
I see so many of these conversations turn to palliative and hospice care with the excuse that they treat the whole person, saving them from side effects of the treatments that probably won't save their lives. Some people simply don't want to die, and they are willing to "suffer" to see another day. Younger (
Patients have the right to choose curative care if they desire, even when there is little statistical chance that the curative care will indeed extend their life, improve quality of life, or change the outcome of the disease process. Yes, factual and honest discussions about the nature of the patient's diagnosis and prognosis are sometimes difficult and uncomfortable for the patient and family. Of course discussions about a terminal condition with presentation of all options including palliation of symptoms and hospice will influence the decisions of the patients, that is why we provide it. Patients can continue to have hope even when they are in hospice. If their hope is faith based they begin to realize that their God may perform miracles when, where, and how He prefers.
When people have a terminal dx with a limited lifespan anticipated the best policy is to stop dancing around the rainbow and quickly assist the patient in determining what they want the remainder of their days to look and feel like and then get busy trying to help them accomplish that. Time is of the essence and something that these patients have a short supply of, IMV.
All patients have the right to be told the honest truth about their health status and prognosis.
Specializes in NICU, PICU, Transport, L&D, Hospice.
If you feel this way, you have the right to make the decision to forgo curative care for yourself. Other people have their own values.
The fact that medical care is so expensive is not the fault of the patient.
As I posted earlier, the federal government cannot run out of money.
We are all aware that there are providers and facilities which will engage in futile and unnecessary care because it will make them money, even if it will have absolutely no positive impact upon the life of the beneficiary. There are some who will not. The patient wanting futile care will have to seek out those medical providers who will accomodate that request. Health professionals have their own ethics and morals to deal with.
Patients get to self actualize their end of life care after they have received the information pertinent to their dx, prognosis, and options for care. They will choose what they will choose. They sometimes are not able to get what they really want, but they still get to choose.
The fact that medical care is so expensive is a concern of the healthcare professional and those trying to spread dollars across a huge range of health care needs. What percentage of the GDP do you think healthcare should occupy, it is close to 17% now, isn't it? How do we address this if not by having hard discussions about where the bulk of the $$ are spent and evaluating whether those $$ are doing what they are intended to do?
We are all aware that there are providers and facilities which will engage in futile and unnecessary care because it will make them money, even if it will have absolutely no positive impact upon the life of the beneficiary. There are some who will not. The patient wanting futile care will have to seek out those medical providers who will accomodate that request. Health professionals have their own ethics and morals to deal with.
Patients get to self actualize their end of life care after they have received the information pertinent to their dx, prognosis, and options for care. They will choose what they will choose. They sometimes are not able to get what they really want, but they still get to choose.
The fact that medical care is so expensive is a concern of the healthcare professional and those trying to spread dollars across a huge range of health care needs. What percentage of the GDP do you think healthcare should occupy, it is close to 17% now, isn't it? How do we address this if not by having hard discussions about where the bulk of the $$ are spent and evaluating whether those $$ are doing what they are intended to do?
Bingo, but I doubt that this will change the OP's mind because the goverment has "unlimited" money. If the money is "unlimited", why are doctors at the receiving end of drastic Medicare payment cuts? This will only drive more doctors away from accepting Medicare patients. When patients get to choose their treatments, we are left with unbridled use of antibiotics, C-sections on demand and direct consumer advertising for drugs that have no proven benefits. It's hard enough for those of us in the system to digest all of the nuances of drug research and how incredibly the research system is set up to be of benefit only to the company and not to the patient. The large majority of patients to not have the expertise, time or education to know what choices will mean to them. Women who insist on c-sections do not think about the remote possibility of death, but even though death is rare after c-section, it is on the rise. How is the layman supposed to tease out the rare but deadly consequences of c-section? We're here to care for the patients; not to kill them. Sometimes we are the ONLY people looking out for the patients best interest. Nurses have no financial interest in therapies - we are on salary.
If you feel this way, you have the right to make the decision to forgo curative care for yourself. Other people have their own values.
The fact that medical care is so expensive is not the fault of the patient.
As I posted earlier, the federal government cannot run out of money.
Actually, the behavior of many patients does drive up the costs of medical care.
The federal gov't can't run out of money? There is some truth to that I suppose. But I find it frightening that there are so money people who don't see how that is a huge problem for our society.
Bingo, but I doubt that this will change the OP's mind because the goverment has "unlimited" money. If the money is "unlimited", why are doctors at the receiving end of drastic Medicare payment cuts? This will only drive more doctors away from accepting Medicare patients. When patients get to choose their treatments, we are left with unbridled use of antibiotics, C-sections on demand and direct consumer advertising for drugs that have no proven benefits. It's hard enough for those of us in the system to digest all of the nuances of drug research and how incredibly the research system is set up to be of benefit only to the company and not to the patient. The large majority of patients to not have the expertise, time or education to know what choices will mean to them. Women who insist on c-sections do not think about the remote possibility of death, but even though death is rare after c-section, it is on the rise. How is the layman supposed to tease out the rare but deadly consequences of c-section? We're here to care for the patients; not to kill them. Sometimes we are the ONLY people looking out for the patients best interest. Nurses have no financial interest in therapies - we are on salary.
I agree with you that there are abuses both in terms of over treating and under treating patients. Of course there are health care providers who practice negligently. But this has always been the case, and will always be true.
Which patients should have a say in their treatment? Is it only those with good insurance? Patients with a college education?
So which patients do you propose choosing treatments for? Is it those receiving Medicare with chronic illnesses? Terminal diagnoses? Medicaid? Women receiving government funded maternity care? Those with only a high school education?
Medicare has cut payments to 721 hospitals with the highest rates of patient infections and injuries. I assume you are pleased about the cost savings to the government. But perhaps you believe the hospitals should not be penalized.
Do you also object to the large amount of money Medicare pays for hospice care? Medicare pays a lot of money for the provision of hospice care. See the article in Bloomberg: "Aunty Midge Not Dying in Hospice Reveals $14B Market." Our family has a friend who has been receiving hospice care for over a year.
It seems as though the Medicare reductions have spurred health care facilities to action: In my area, physicians have taken to the media to broadcast the advantages of choosing hospice care and palliative care over curative care (the health care facilities have developed new hospice and palliative care programs).
Let's not forget the tax breaks health care facilities receive, and let's not forget the enormous investment capital that flocks to health care stocks traded on the stock exchanges. In regard to non-profit and not-for-profit organizations, in exchange for non-profit status, or not-for-profit status, health care organizations are required to provide a certain amount of "charity care." In my area, health care facilities are announcing large profits and are expanding their facilities.
dudette10, MSN, RN
3,530 Posts
Sometimes hope is all they have.
i had a patient diagnosed with lung cancer, and five days after diagnosis, a doc mentioned likely outcomes. The patient said to me, "I haven't gotten used to my cancer, and he already told me I'll probably die. What about hope?"
I see so many of these conversations turn to palliative and hospice care with the excuse that they treat the whole person, saving them from side effects of the treatments that probably won't save their lives. Some people simply don't want to die, and they are willing to "suffer" to see another day. Younger (