There's a lot to discuss in here. Overall, yes, this is an issue.
There's a lot to discuss in here. Overall, yes, this is an issue.
Something they don't mention is lawsuits. Sorry, lawyers, but some of your colleagues would be happy to help a different family sue for that same 87 year old lady not getting a defibrillator. Of course that sort of thing influences doctors and hospitals. And costs money and terrible stress and gets reported in databases, etc.
Another issue is that we do not have and will probably never have an extensive set of evidence based data on people over 65. I mean, we are starting to see some studies on people over 65, but at most I expect our info to push up to maybe 75, nonetheless still incomplete. So it's very hard for doctors to have certain discussions about "the best, worst and most likely outcomes."
In addition, our system does not provide such awesome post operative care and support. It assumes you have a personal support network. It argues about paying for help and support and rehab and transportation, etc., etc. We do not have a system of patient advocates and ombudspersons to ensure a steady maximization of outcomes in terms of quality of life and recovery.
I know of people who are not stuck in a nursing home only because they had enough money personally to pay for help at home and rehab beyond what was officially allowed. Something simple, like having to go up steps to get into your home can get you permanently stuck in a nursing home.
I can tell you from personal experience that the home wound care instructions given to untrained patient family members is woefully inadequate in many cases. Try getting medicare to pay for home nursing visits, even one or two to help train said family members.
We don't have a consistent continuum of care. We do the surgery, and we're done. It is absolutely true that too many surgeries are done, but the quality of life result has just as much to do with what happens after the surgery, and we're not good at that.
Lastly, there's a historical pendulum. We used to look at people over a certain age and figure, eh, they'll be dead anyway in 5 years or less, and not offer them much, even if we could have. Now, we're overdoing it the other way, but I'd hate to see a return to oh, you're old, whatever.
https://www.npr.org/sections/health-shots/2018/02/28/589282187/too-late-to-operate-surgery-near-end-of-life-is-common-costly
https://www.npr.org/sections/health-shots/2018/02/28/589282187/too-late-to-operate-surgery-near-end-of-life-is-common-costly
Something they don't mention is lawsuits. Sorry, lawyers, but some of your colleagues would be happy to help a different family sue for that same 87 year old lady not getting a defibrillator. Of course that sort of thing influences doctors and hospitals. And costs money and terrible stress and gets reported in databases, etc.
Another issue is that we do not have and will probably never have an extensive set of evidence based data on people over 65. I mean, we are starting to see some studies on people over 65, but at most I expect our info to push up to maybe 75, nonetheless still incomplete. So it's very hard for doctors to have certain discussions about "the best, worst and most likely outcomes."
In addition, our system does not provide such awesome post operative care and support. It assumes you have a personal support network. It argues about paying for help and support and rehab and transportation, etc., etc. We do not have a system of patient advocates and ombudspersons to ensure a steady maximization of outcomes in terms of quality of life and recovery.
I know of people who are not stuck in a nursing home only because they had enough money personally to pay for help at home and rehab beyond what was officially allowed. Something simple, like having to go up steps to get into your home can get you permanently stuck in a nursing home.
I can tell you from personal experience that the home wound care instructions given to untrained patient family members is woefully inadequate in many cases. Try getting medicare to pay for home nursing visits, even one or two to help train said family members.
We don't have a consistent continuum of care. We do the surgery, and we're done. It is absolutely true that too many surgeries are done, but the quality of life result has just as much to do with what happens after the surgery, and we're not good at that.
Lastly, there's a historical pendulum. We used to look at people over a certain age and figure, eh, they'll be dead anyway in 5 years or less, and not offer them much, even if we could have. Now, we're overdoing it the other way, but I'd hate to see a return to oh, you're old, whatever.
https://www.npr.org/sections/health-shots/2018/02/28/589282187/too-late-to-operate-surgery-near-end-of-life-is-common-costly
https://www.npr.org/sections/health-shots/2018/02/28/589282187/too-late-to-operate-surgery-near-end-of-life-is-common-costly
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