January 11, 2012

"To help prevent overtesting and overtreatment of older patients — or undertreatment for those who remain robust at advanced ages..."

"... medical guidelines increasingly call for doctors to consider life expectancy as a factor in their decision-making. But clinicians, research has shown, are notoriously poor at predicting how many years their patients have left."

So, let a website figure it out: ePrognosis.

As Bette Davis once said: "I think I'll have a large order of prognosis negative!"

***

"Oh, Ann. Don't be sorry. About anything."

54 comments:

David said...

Physicians are to "consider life expectancy as a factor in their decision making."

One person death panels, eh?

Or will they just refer it to the committee, which will use the guidelines?

edutcher said...

This sounds like some of Dr Berwick's doing, although one of the big cost factors in Medicare has been that doctors will order every test available because they know the Feds are paying for it,

Even so, it still has that "death panel" vibe to it.

Ann Althouse said...

"Oh, Ann. Don't be sorry. About anything."

Never apologize, mister. It's a sign of weakness.

So, let a website figure it out: ePrognosis.

The Blonde can look at someone (or even take a good sniff) and have a pretty good idea of how much time they have, particularly if they have any kind of catastrophic illness.

chickenlittle said...

The true sign of intelligence is not gnosis but imagination.

chickenlittle said...

BTW, Bette wears gorgeous fur in the video clip!

sydney said...

From the article:

Keeping blood sugar below 7 percent on the commonly used A1C hemoglobin test can lower diabetics’ risk of complications like kidney disease. But it can take eight years or longer of daily monitoring, dietary restrictions, exercise and medications for that protective effect to appear.

“Say an older patient is tired of having to be so meticulous and attentive to blood sugar all the time,” Dr. Yourman said. “If she’s unlikely to live for five years, it’s questionable whether she will really benefit from tight glycemic control.”

With an accurate idea of how long the patient might live, her physician might decide her quality of life will improve with less stringent measures to manage diabetes, Dr. Yourman said.


So true! But, the stimulus package of 2009 contained a little thing called the HITECH act which ties physician Medicare payments to "quality" measures such as how well controlled their diabetic and hypertensive patients are. This doesn't go into effect until 2014 or 2015 - but in the future physicians expect to be penalized if the elderly don't meet certain parameters. So much individualized treatment!

edutcher said...

chickenlittle said...

BTW, Bette wears gorgeous fur in the video clip!

Somebody tell Peter.

WV "subfir" (no kidding) Go for it...

MayBee said...

ISTM if someone needs life-extending treatment and you don't give it to them, it makes predicting life expectancy much easier.

"I though this person wouldn't live much longer, so I didn't give him a pacemaker. And he died. So I was right"

Rusty said...

This sounds like some of Dr Berwick's doing, although one of the big cost factors in Medicare has been that doctors will order every test available because they know the Feds are paying for it,




No. Because if they don't order the test and something goes wrong they'll get sued for not doing the test. Medicare isn't the reason doctors liability premiums are so high, lawyers are.

DaveW said...

This talk pisses me off to no end. Everyone gets old, gets sick and dies at some point. The idea that we should withhold treatment for people that are old and sick is flatly evil. You don't need medical care when you are young and healthy.

traditionalguy said...

Free anything is always over utilized...why not?

The numbers of weak minded and weak bodied elderly folks with nothing to do but go to Doctors is enormous already.

And we have no available post war baby boom to do all of the work from ages 20 to 60 like our parents had when they voted themselves Free Medicare and Social Security cost of living raises and Disability income for the lazy.

Without a return of famine and plagues there is no way to handle this.

So Obama has turned our Government Agencies into devices to cause intentional energy cost inflation to raise food prices. And I would bet there is also increased funding for new research into Bio-warfare uses of antibiotic immune infecteous diseases.

I am not paranoid, but I do see real enemies targeting us.

deborah said...

Don't let's ask for the moon, when we have the stars.

Dan in Philly said...

*sigh*

People are easy to predict in the macro, nearly impossible in the micro. I think this is true, though I can't understand how this should affect government policy.

Richard Dolan said...

Very odd since the "decision making" about medical treatment is made by the patient or her surrogate (always nominally and most often substantively too). Doctors recommend for or against treatments, and can surely take into account whether the treatment will provide any actual benefit (considered broadly), or whether the benefits are outweighed by other factors. But a professional's recommendation is supposed to be accompanied by sufficient disclosure to allow the patient/client to make an informed decision.

The exception arises where, because of a lack of supply (suitable hearts for transplant, e.g.), certain treatments cannot be available to all who may need them. Scarcity requires that an allocation among patients be made. But that is not what this article is about.

I doubt that doctors would make many horrendously bad choices even if they exercised decision-making authority in these circumstances. Unlike Obama I don't think any significant number of doctors make their treatment recommendations based on financial or other non-medical considerations (all those imagined toncillectomies O conjured up, for example). Medicine is bureaucratic and impassive on the macro scale, but usually quite humane at the micro/individual patient scale. Yet this is one area where the procedure is itself an important value -- patients (or their families or surrogates) have to make the life-and-death decisions, since they have to live (or die) with them.

Where the person making those decisions is not required to bear the cost, there are always difficult cases at the margins. Services for which no payment or personal expense is required are often valued as cost-free, which they obviously aren't. But however the marginal case is dealt with, it shouldn't dictate the approach in the vast majority of non-marginal cases.

PatCA said...

I'm sure the Obamacare apparatchiks stand willing to help with such "predictions."

denmotherblog said...

Remember when HillaryCare was going to regulate treatment given in the last six months of life? Nobody in the administration ever explained how that would be possible. Maybe the government was going to wait until the patient died and them demand repayment of all the treatment it covered in the prior six months.

EDH said...

Seinfeld - "Prognosis: Negative" Movie Trailer

wv - "mormed" = what Romney has done to his opposition

ic said...

Clinicians are absolutely confident at predicting how many years of their own lives and future lost with a malpractice lawsuit.

Smilin' Jack said...

"... medical guidelines increasingly call for doctors to consider life expectancy as a factor in their decision-making.

There are no more "doctors"--people you used to pay to give you health care. Now there are "providers"--people paid by insurance companies to not give you health care.

Chip S. said...

Is Althouse hoping that, when full cost controls are in effect, the formula for determining the level of treatment received will include the number of hits on one's blog as a positive factor?

Crunchy Frog said...

I have a friend at work whose mom is going in for heart AND cancer surgery.

She's 87, and incapable of living on her own.

Maybe death panels are the way to go.

wv: ciacari - comes standard with rich Corinthian leather

cokaygne said...

The time the doctor, er, provider, spends with a dying patient is time that he or she cannot spend with some other patient. What is the answer? More doctors educated at government expense? Somewhere, at some time at some point, there will not be enough resources. Someone has to decide. That is the fallacy of national health insurance. The arguments made in favor of national health insurance always come down to demonization of greedy and wicked private insurance companies that say "no" to life saving treatments. Maybe the government is not greedy and wicked, but it will face the same challenges as the insurance companies. Even if there are no death panels, there will be limits on the number of doctors or hospital beds or medications. There has to be. Better to gradually phase out all third-party payment and let the patient decide these things on their own dime. This nonsense will bankrupt our grandchildren.

toby said...

Thanks to attorneys, most of the over testing is on children and young adults. The older you get, the less likely a plaintiff's attorney will take a malpractice case. So, the defensive medicine is mostly on the patients attorneys will take in a heartbeat. The bonanza are infants, 65 years of loss of earning capacity! Grandma has zero years, so the ambulance chasers say "fuck her" even if there was malpracice. Most people don't know this very basic fact.

Pastafarian said...

"Better to gradually phase out all third-party payment and let the patient decide these things on their own dime."

This is absolutely right. The problem isn't that there are people without insurance; the problem is that most people have insurance, and this has skewed their own cost/benefit analysis for every medical decision from end-of-life to a trip to Urgent Care for stitches.

If there was no medical insurance, medical care would be almost as cheap as going to an accountant or auto body shop. If we had gasoline insurance, gas would cost $50 per gallon.

John Lynch said...

Ecological fallacy. Average life expectancy tells you nothing about an individual patient. Since doctors treat individual patients that's a big problem.

Individual life expectancy is also hard to measure. People can have cancer and then live for decades. Or they can die of something completely different. I've had friends with cancer live and I've had friends who died in car accidents. We don't really know anything beyond the certainty that we'll all die eventually.

Doctors are supposed to push that reckoning as far into the future as possible. Accepting death isn't their job, except perhaps at the very, very end. Perhaps.

I'd rather they did their job instead of rationalizing that it's all a doomed struggle.

The big problem, it seems to me, is making the insurance company or the government rather than the patient the real consumer of health services. Ultimately, who pays decides.

Stoutcat said...

deborah said...
"Don't let's ask for the moon, when we have the stars."

Wrong movie, but an understandable mistake: Victory, Voyager; potato, potahto.

cassandra lite said...

Paging Dr. Palin. Dr. Palin to the clinical life-expectancy-estimating room. Stet.

Methadras said...

Death panel precursor guidelines says what?

Triangle Man said...

What?

Pogo said...

Seems that leftists always end up demanding for the death of other people at state hands.

traditionalguy said...

A-Fib is a heart arrhythmia ( an electrical signal dysfunction) caused by aging. Its affects are blood clots that can be controlled by blood thinners, but they require monitoring tests monthly.

Putting all folks over age 60 on those blood thinners would be an effective Life Panel for many.

Otherwise, blood clots form that cause death when they break lose and get into a heart artery or terrible stroke damage/death when they get into a brain artery.

Have a nice day.

Original Mike said...

More hubris; "we know when you're going to die."

Original Mike said...

"The big problem, it seems to me, is making the insurance company or the government rather than the patient the real consumer of health services."

This.

deborah said...

"Wrong movie"

I knew that and just took an excuse to post a great Davis quote :)

paul a'barge said...

Death Panels, straight up.

R. Chatt said...

Some people seem to miss the point. Perhaps an analogy would help: If you have an older car and it hasn't been well maintained, should you spend a lot of money to do major repairs or let it go? However, if the car has been well maintained it might be worth doing the repairs and keeping the car for a little longer. (My car is a Toyota Pickup, 1986. It has over 180K miles, has been very well maintained, inside and out. Lately I drive less than 3K miles a year. I spent $2500. recently to replace the tires, brakes, and clutch -- much cheaper than buying a new car. Of course if my self esteem or ego were linked to what car I drive then I'd have to have a new car, maybe a Jaguar or BMW.)

Longevity is a virtue and we should do all we can to maintain our health to live as long as possible as well as possible. There comes a point when a person's body wears out and we have to make a choice whether to make them as comfortable and serene as possible versus using every medical technique available. Running tests and trips to the hospital and doctors are very stressful to that individual, and of course expensive. For some people it's inconceivable that everything that could be done not be done to extend the life. This is more egotism than anything else.

As RichardDolan points out, these are difficult decisions the family makes with the best interest of the patient in mind. Always has been this way. Somehow maybe the website makes it more objective? But medicine is an art, not an exact science.

Wally Kalbacken said...

Take Levine, Mazzaglia and Di Bari off of the Christmas card list!

Original Mike said...

"Some people seem to miss the point. Perhaps an analogy would help: If you have an older car ..."

Jesus. People are not cars.

rhhardin said...

It is true that you spend a lot less time in doctors' offices if you don't go to the doctor.

Ask any guy.

tim in vermont said...

Hawking was supposed to be dead decades ago.

But, on the other hand, I know somebody who worked in a nursing home and she left because basically she was ordered to provide speech therapy to elderly people who did not like it, and were very unlikely to improve with therapies meant for victims of trauma.

Why was she told to do it? So they could bill medicare.

There is a middle ground here, but witholding life extending care based on some fuzzy, error prone criteria is just brutally evil.

Original Mike said...

"So, let a website figure it out: ePrognosis."

I've always said Bill Gates would be the death of me, but I thought I was joking.

Mark O said...

Obama thought his "typical white person" grandmother lived too long. What a guy.

tim in vermont said...

Black Male life expectancy 69 yrs
White Male life expectancy 75 yrs...

Cedarford said...

DaveW said...
This talk pisses me off to no end. Everyone gets old, gets sick and dies at some point. The idea that we should withhold treatment for people that are old and sick is flatly evil.
===================
When people are told a pricey commodity is instead a right and a freedom to demand as much as they want of for free, and 'society' if need be, will pick up 100% of the tab - naturally - they will use as much as they can. Granny has Alzheimers and needs heart surgery - well - Sure we won't lose a cent of her eventual inheritance..this is all free? Well, then lets always err on the side of life! Precious life. Cut foreign aid to them thar starving Ethiopeans, instead!!

Gene said...

As RichardDolan points out, these are difficult decisions the family makes with the best interest of the patient in mind.

I only wish they always did. I know a doctor who used to run the intensive care unit at a big county hospital. She once bitterly told me that she often encountered families that refused to give permission to pull the plug on the most terminal of patients because they didn't want the patient's social security, welfare or pension checks to stop.

These useless life extensions ended up costing the county (i.e. the taxpayer) tens of thousands of dollars for no good result, money that the hospital really needed for much younger people or people who had a far better prognosis.

Cedarford said...

R Chatt - "For some people it's inconceivable that everything that could be done not be done to extend the life. This is more egotism than anything else."

A lot of these Right To Lifers are just posturing. Same with welfare mammies that produce heroin addicted, multiple-handicapped preemies with fetal alcohol syndrome that demand "The Best". Tell the welfare mammy that "The Best" in superheroic care will cost her 20% of her food stamp and welfare check for the next 5 years and she will be in with a pastor preparing for "Little Tawanikka's journey to Heaven"...And the RTL'rs will assimilate the news that heroic care will leave nothing of Granny's house and savings to them - it will go to the Hero doctors and techs and hospital instead, and they will act more sensibly.

=====================
Pastafarian - "If there was no medical insurance, medical care would be almost as cheap as going to an accountant or auto body shop. If we had gasoline insurance, gas would cost $50 per gallon."

Simplistic and incorrect. We can look at some affluent, Free Market for Freedom Lovers!! - but nevertheless backward Arab countries to see that healthcare prices are not dramatically lower than in countries with advanced societal healthcare systems. IT IS TRUE, though, that our present system is far more costly (50-60% more) than what advanced Asian and European competitor nations pay per capita.

And we can look into other sectors of society to see that Free Markets for Freedom Lovers!! does not lower the price for all things accordingly, or hold the cost of many goods and services and cost of labor at rock bottom. And while "miracle high tech!!" makes some things cheaper, it makes other things far more expensive.

R. Chatt said...

@ Original Mike said... (quoting R. Chatt)
"Some people seem to miss the point. Perhaps an analogy would help: If you have an older car ..."

Jesus. People are not cars.

An analogy: a comparison between two things, typically on the basis of their structure and for the purpose of explanation or clarification.

Bodies are vehicles. We are spiritual beings inhabiting physical bodies, although we don't always fully grasp that. The spirit/soul is eternal, the body is not. I'm pretty sure Jesus would agree.

Alex said...

More death panels.

ironrailsironweights said...

Hey, this is America, we think it wonderful to spend $500,000 on heroic treatments that might extend a hopelessly senile 90 year old's life by a week or two.

Peter

Alex said...

Hey, this is America, we think it wonderful to spend $500,000 on heroic treatments that might extend a hopelessly senile 90 year old's life by a week or two.

It's about valuing human life down to the last second. The moment we compromise and say that 90yo senile man is not worth saving, we've devalued all human life.

Gahrie said...

Granny has Alzheimers and needs heart surgery - well - Sure we won't lose a cent of her eventual inheritance..this is all free? Well, then lets always err on the side of life! Precious life. Cut foreign aid to them thar starving Ethiopeans, instead!!

Well why not? Why should the lives of those "starving Ethiopeans" have a higher moral or ethical value than Granny's life?

Cedarford said...

Alex said...
Hey, this is America, we think it wonderful to spend $500,000 on heroic treatments that might extend a hopelessly senile 90 year old's life by a week or two.

It's about valuing human life down to the last second. The moment we compromise and say that 90yo senile man is not worth saving, we've devalued all human life.

===============
That sort of thinking worked fine in a day when the mindset that America had unlimited financial resources was prevalent.

Now we have harder choices - spend a half million to prolong the life of a dying patient in a coma another two weeks even if it means downsizing another 3 Marines or closing a National Park for a week? Add the wasted money in healthcare past the individual into the aggregate and you start talking about either raising taxes even more, bringing back the estate tax to underwrite healthcare for heroic and futile "life extension" efforts, or cutting whole air wings from the AF, selling off national parks, or otherwise cutting Government expenses.

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raf said...

There comes a point when a person's body wears out and we< have to make a choice whether to make them as comfortable and serene as possible versus using every medical technique available. Emphasis added.

If it were not for the almost universal third-party payment of medical expenses, that pronoun could be singular. All the agonizing over the cost of healthcare versus foreign aid, etc, springs from the fact that the government is involved. Is there any other industry where we see explosive growth and worry about the total cost? Do you know how much of our GDP the electronic gadget industry consumes? Do you care? If healthcare were market-funded, its growth would be something to celebrate. And invest in.