Letters to the Editor
New York Times
letters@nytimes.com
October 6, 2011
Recently, you reported that towards the end of a patient’s life, surgery becomes much more common. This is interesting because the issue creates friction between the growth of health technology and an inability to pay for new treatments. Thus, as pharmaceuticals develop new surgical products, our nation will be unable to pay for the mounting debt as health expenditures grow to nearly 18% of the GDP.
As a student, I challenge the status quo: why should elder patients utilize surgery to lengthen their lives marginally while my generation will endure the burden of future debt? Doctors should be mandated to have sensitive conversations with our older, wiser folks to cut the plug earlier—it would make a difference to our country’s future economic vitality.
Sincerely,
Vineet Pandey
In Response to:
http://www.nytimes.com/2011/10/06/health/research/06medicare.html?ref=health
Are you really saying that we should do away with our goal of extending lives for as long as we can? I totally agree with the fact that our age group will be in debt soon because of steady technological usage, but I certainly believe there is a way to continue lengthening lives of the elderly while bringing down the GDP we are spending at the same time. We just need to take the time to find the solution. The difficultly I am having with your argument stems from the fact that I just lost my father to pancreatic cancer two weeks ago. We knew he was going to eventually pass, but never would I be able to live with the idea of the US saving money by just "having a sensitive conversation" with him and not attempting to extend his life. In my opinion, that's quite immoral, don't you think?
ReplyDeleteDid somebody say death panels? While the challenges to affordable care, especially for the aging boomer generation, seem insurmountable, I think we can give our parents and grandparents a comfortable end of life without compromising our own future. Many expensive surgeries are preventable; for example, hip replacements after a fall are shown to be greatly reduced by ramps, handrails, and proper training for emergency response crews. I believe in the importance and success of creative public health campaigns and innovations. And that's where we come in--no one else will do it for us!
ReplyDeleteI have to agree with the other commentators that have already brought up some good points. I believe that there are other ways of approaching this issue and simply trying to encourage a family to discuss when and how to end the life of a loved one is not a legitimate nor effective way of addressing the growing percentage that health expenditures makes of our nation's GDP. For me, this article provided me with yet another example of how important preventative medicine is to making public health efforts more real and effective. While some diseases and health problems can very well be unexpected, the importance of primary care and its goal in disease prevention and management prior to the onset of disease should be one of our nation's top priorities when it comes to healthcare. In order for us to even begin finding solutions to reducing healthcare costs, we have to recognize that educating the public on how and why certain diseases develop the ways that they do in addition to emphasizing the care that primary care physicians can provide are essential.
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ReplyDeleteI find this conversation a very difficult one to approach. This topic can be approached from a more "economical" sense or it can be approached from a more "ethics-based" standpoint. The economical argument can be made that it saves money for the system and for the family. The ethics-based argument can be made that the goal is to save as many lives and ensure the longest (and healthiest) life possible. Though I see where you're coming from, for me the ethics-based argument really rings true to me. It just seems to difficult to imagine a healthcare system that would not work towards ensuring care for an individual or community in need. I also agree with the first comment that the idea of just "having a sensitive conversation" with older or sick folks will help resolve the issue and/or will be received well. I think in many ways this would come off somewhat offensively to the patient and not be an effective conversation.
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ReplyDeleteI agree with everyone here in that prevention should be a prime focus. But also doctors do need to be able to have sensitive conversations with their patients. I don't think that can or should be avoided. And from my knowledge of the medical school system, there is no training given for these kinds of difficult conversations. But even if doctors had these conversations, if the patient still decided to opt for surgery, healthcare costs would continue to rise. I feel like some elderly patients and their families would still opt to get these end of life surgeries because they are scared and desperate. But doctors definitely cannot be mandated to have these conversations. It would be very difficult to enforce this policy because these conversations need to be had with patient privacy in mind so they cannot be recorded or monitored.
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