Medical Best Practices: For Who?

One of the political mandates of the proposed Obama Healthcare initiative features a reliance on statistical “best practices” to lower costs and provide adequate medical care. Unfortunately, as you age, the outcomes of medical procedures grow progressively worse – suggesting that it may be more cost effective to ameliorate your pain and just let you die rather than funding extraordinary medical interventions or using expensive drugs. Truly restricting medical care to those who by wealth, power or position can exert influence on the system – or, in the Obama era, being a member of a union.

Advancing a political ideology and agenda based on a non-existent healthcare crisis …

Here is a President and an Administration that would destroy our present healthcare system to achieve political control over our nation. Ostensibly to extend medical care to an additional 16 million people (estimated by the CBO) of which 10-14 million might be illegal aliens.

“The CBO concluded that under the Kennedy plan, ‘the net decrease in the number of uninsured people would be about 16 million’ - far short of Obama's goal to provide healthcare coverage to all Americans.”  <Source:CBO>

An example of best practices which suggests it is more cost effective (under certain circumstances) to let you die after suffering cardiac arrest in a hospital setting …

“CPR for hospitalized patients is associated with poor outcomes, as the cause of arrest is usually associated with advanced chronic illness rather than an easily reversible acute cardio-pulmonary event (e.g. isolated arrhythmia). When talking with patients about CPR, physicians can say roughly 15%, or 1 in 6 patients, who undergo CPR in the hospital may survive to discharge. However, specific co-morbidities will reduce the chance of survival, and surviving patients are at risk for a range of CPR-related complications including permanent neurological and functional impairment.”

Do you want a bureaucrat or a computer system to issue a DNR (Do Not Resuscitate) order based on the statistical likelihood of a  poor outcome?  Or not to use that expensive procedure or drug which could save your life? 

“Survival to discharge following cardiac arrest occurring in the hospital is infrequent.”  (Source: Fast Fact and Concept #179:  CPR Survival in the Hospital Setting; David H. Ramenofsky and David E. Weissman MD)

• “Survival 20 minutes after CPR was 44%, but only 17% of all CPR patients survived to discharge. The survival to discharge for ventricular fibrillation and pulseless ventricular tachycardia was 34% and 35%, respectively, but only 10% for asystole and pulseless electrical activity.”
• “Factors predicting survival to discharge included myocardial infarction, coronary heart disease, and hypertension.”
• “Factors which predicted a failure to survive to discharge included:
  • Sepsis the day prior to the CPR event [infection]
  • Serum creatinine >1.5 mg/dl [impaired kidney function]
  • Metastatic cancer
  • Being African-American (this risk factor has subsequently been challenged) 
  • Dementia
  • Dependent status.”

The Medical Power of Attorney …

In many cases cardiac resuscitation may be classified as chemical (using drugs), electrical (using defibrillators), physical (chest compressions) or all three.  All with various medical consequences.

Normally the wishes of the patient, usually derived with the assistance and advice of a doctor, is honored without regard to cost or potential outcome. At some point, it becomes a decision for the attending physician who often evaluates the probability of survival and the quality of life after surviving the event. And it is my opinion that NOTHING should stand between the patient and the doctor in matters of healthcare – and certainly not an artificial bureaucracy that is incentivized by denying care to an aging population or by using statistical outcomes.

What can you do?

Be sure to demand that your elected officials read and understand the legislation they are promoting and signing.

Be sure that you have a durable medical power of attorney that expresses your wishes should you be incapacitated.

Be sure that medical decisions are made by physicians rather than bureaucrats or politicians.

-- steve

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OneCitizenSpeaking: Saying out loud what you may be thinking …

Reference Links …

Fast Fact and Concept #179