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Tribune-Herald - January 11, 2011New Search
Michael Attas:
Recognize the value of painful conversations
Waco Tribune-Herald (TX) - Tuesday, January 11, 2011
Author: MICHAEL ATTAS Guest columnist
All
he wanted to do is go home to watch his momma cows and their babies. His land,
his cattle and his family had defined his life. And he wanted to die in their
arms and in their presence.
I had taken care of him for nearly 20 years and had gotten to know him and his
children well.
He was a rancher and, unfortunately, his heart disease was rapidly advancing.
He had experienced repeated hospitalizations for congestive heart failure and
was running out of options.
So, along with his wife and children, we began to have conversations about his
future and his options.
These discussions were necessary and heartbreaking. We began to discuss things
like Home Health Hospice, do-not-resuscitate status, life support systems and
approaches to end-of-life decisions.
I had these same conversations with my mother three years ago before she died.
They were painful, honest conversations. I didn’t like having them, yet they
became healing as she moved to the end of her time.
I needed to help her sort through these things, as her own doctor didn’t take
the time to have such dialogue. And that gets to the heart of what is perhaps
the most crucial issue before American physicians and patients.
It astounds me that the federal government and private insurers are willing to
pay exorbitant fees for technical procedures at the end of life that are
neither medically advisable or proven effective.
Yet they are unwilling to spend money for something as simple as “time” for a
physician to discuss with a patient end-of-life issues.
We spend almost 20 percent of our federal health dollars on end-of-life
treatment that is known to be futile.
We can place a defibrillator that is not going to prolong life, we can put a
stent in that is not indicated, or we can dialyze patients with terminal cancer
and who live in nursing homes.
And when we do those things, we are reimbursed handsomely. Yet when we spend 10
or 20 hours with patients and families in their time of greatest need, the
powers have decided it is without economic value.
Because there is no billable code for that time, it is time that is essentially
donated. I personally find those times with patients among the more emotionally
and spiritually rewarding of anything I do in medicine.
Yet as a society, we seem to value technology over wisdom. We value procedures
over guidance. And our patients are often left in the dark when they need us
most.
Health care experts have talked about the disproportionate reimbursement for
procedures as opposed to cognitive input and time.
There is a trend in medicine to finally begin to pay for cognitive skills and
not just procedural skills. And this is a wonderful example of the problem.
An honest discussion about end-of-life options and treatments are one of the
most valuable and caring things we can do for our patients.
To claim that this is going to result in “death panels” is simply political
demagoguery. When a politician resorts to this sort of insult to our
profession, it is obvious he or she has not had a loved one in these
situations.
Let us honor the lives of our patients by finding a way to validate discussions
that are important.
Let us create a loving, supportive system that will encourage all providers to
have honest and realistic discussions about end-of-life issues — and then be
reimbursed fairly and respectfully.
We owe nothing less to our patients. I am certain of one thing — one day we all
will want to be treated with the same respect and dignity.
Michael Attas is a local doctor, a medical humanities professor and an
Episcopal priest.
Section: accesswaco
Record Number: 01112011-wac-attas11
(c) 2011 Robinson Media Co. LLC - Waco Tribune-Herald
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