Prevention and Palliation: Together Forever

What do the following patients have in common? A 45 year old man who has a 60 pack-year history develops lung cancer and is diagnosed at an advanced stage.* A 33 year old woman with post-traumatic stress disorder who has been drinking since the age of ten and develops fulminant hepatic failure. An 82 year old man ends up in the surgical intensive care unit after a self-inflicted gunshot wound three months after his wife of 60 years dies. The mother of a 55 year old woman with morbid obesity, obstructive sleep apnea, and pulmonary hypertension laments that the park nearby isn't safe for people to use. All four patients are candidates for palliative care.  All of them also have potentially preventable illnesses.  When I see patients like this, I sometimes ponder their plight from a six-sigma perspective.  From a societal, public health, and healthcare system standpoint, what were the six missed opportunities which could have helped ensure that the patient before me stood a chance to avoid their illness?**  The healthcare system brings it's resources to bear too late.  Is the patient with lung cancer a candidate for a tyrosine-kinase inhibitor? What are the benefits of pentoxifylline for the second patient?  Should the third patient receive mannitol?  Is the last patient a candidate for sildenafil? While not unimportant questions, at times it feels like rearranging the deck chairs on the Titanic.  From day one of medical school, I had ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - Category: Palliative Carer Workers Authors: Source Type: blogs