Right Care Action Week — rational care

I wrote yesterday about how a broken healthcare system favors overuse of procedures. Today I will discuss rational care. Remember the goals of the Lown Institute: We think healthcare should be affordable, effective, rational and available to all. Rational means in accordance with reason or logic. Hardly a day goes by that I don’t see irrational care. Why it happens is complicated. Patients may expect irrational care. Doctors and nurses can get pushed into delivering it. Then, insidiously, unreasonable and illogical care become normal; and rational care stands out as an outlier. Some examples: It’s not rational to perform (or offer) CPR to frail emaciated elders. CPR is an intervention–similar to surgery or chemotherapy. We don’t feel compelled to offer drugs or surgery that won’t help. If a patient would get no benefit from CPR, it’s not rational to do it. It’s not rational to avoid asking patients about their end-of-life goals. As medical experts, we understand that death is normal. In taking the oath of Maimonides, we promised to look after the life and death of our patients. The best way to help our patients avoid a bad death (death by ICU, death alone or death in pain) is to 1) ask patients what is important to them, and 2) be rational about how we frame the trade-offs. And there are always trade-offs. We should stand against all who oppose recent the CMS’ proposal to reimburse end-of-life discussions. We let the death-panel...
Source: Dr John M - Category: Cardiology Authors: Source Type: blogs