April 10, 2012

Trend watch: Segregated hospital emergency rooms.

Because there's a class of persons who need different treatment.
There were no beeping machines or blinking lights or scurrying medical residents. A volunteer circulated among the patients like a flight attendant, making soothing conversation and offering reading glasses, Sudoku puzzles and hearing aids. Above them, an artificial sun shined through a skylight imprinted with a photographic rendering of a robin’s-egg-blue sky, puffy clouds and leafy trees.

Ms. Spielberger, who is in her 80s, was even getting into the spirit of the place, despite her unnerving condition. “It’s beautiful,” she said. “Everything here is wonderful.”
If you think that's beautiful, you should see the afterlife.

Or am I taking this the wrong way? The NYT is acting like this is sort of posh. But one look at the headline — "For the Elderly, Emergency Rooms of Their Own" — and my "Death Panels!" red flag went up. Let's make them very comfortable, let's palliate, but let's not save them. The heroic treatments are in that other emergency room, the one for the people who are still useful.

120 comments:

Dan in Philly said...

Deciding who lives and who dies is the price of government run health care. Trying to value the lives of the old against the young is part of the challenge - shall we spend $1,000,000 to extend the healthy life of a 90 year old 1 more year (on average) or will that money be better spent extending the lives of twenty 40 year olds 30 years each?

No one really talks much about this during the whole health care debate, but these are the kinds of decisions you have to make as a society when you decide to go to a government run health care. To each according to their needs, right? Well, every person has an unlimited need to be alive, and they are are gonna die, so the government has to determine who needs to live the most.

Rusty said...

My first thought was Edward G. Robinson in Soylant Green.

Make the old geezers comfortable before we plunge the needle in. Gotta keep the benefits going for the public employees.

tim in vermont said...

The elderly are useful to others. I am glad I knew my grandmother, who died at 96 and was born in 1880, who cooked on a "range" that was wood fired, and sorted her firewood by species to give her temperature control, and who knew the name of every flower, weed, and herb that grew within 10 miles of her home.

I guess though that her last few years were "useless." This is why I am not smart enough to be a liberal.

Scott M said...

shall we spend $1,000,000 to extend the healthy life of a 90 year old 1 more year (on average)

An extreme instance. There are stories out of the UK's NHS where 70ish early cancer patients are written off, only to go abroad for treatment or have their families pay cash, after which they have many years of healthy, happy, productive life.

What's the dollar value of having your kids grow up around their grand parents?

Bob said...
This comment has been removed by the author.
Bob said...

+1 to what Rusty said. Here is the clip.

Matthew Sablan said...

"What's the dollar value of having your kids grow up around their grand parents?"

-- How should I know? I'm not a bureaucratic, unelected member of a panel.

John Burgess said...

My first thought, too, was as Rusty's. Shame on us in the 21st C. that we're not at least providing wall-to-wall nature films as we push the elderly out of the way.

Holmes said...

If we think gay marriage is an intense debate, wait 'til we're all fighting each other and our government over our own health care benefits- who pays, how much, and how soon.

Ann Althouse said...

"My first thought was Edward G. Robinson in Soylant Green."

Yeah, I thought that too. The photo at the NYT. I nearly put that clip in the post.

Ann Althouse said...

"What's the dollar value of having your kids grow up around their grand parents?"

We'll take that into account. Shunt the folks with no grandkids over here.

machine said...

"Death Panels!" red flag went up"..."Deciding who lives and who dies..."


Just have to keep the "Lie of the Year" alive don't you...

Scott M said...

We'll take that into account. Shunt the folks with no grandkids over here.

Full circle. In previous eras, you had more kids to both help you with the homestead and then take care of you when you got old and infirm.

Then we had a couple of generations of birthrate drop as self-centered, me-first types didn't have kids.

Then everyone made sure they had kids to ensure grandkids...just to stay out of the frape line.

Matthew Sablan said...

You know what the phrase Death Panels reminds me of? Mystery Science Theater 3000:

Joel: What do you want for Christmas, Crow?

Crow T. Robot: I wanna decide who lives and who dies!

Troubled Voter said...

there was absolutely nothing in this to indicate death panels. that there was anything that was actually indicative of a "death panel" is a stretch.

this isn't like soylent green. your foisting your own narrow view of what you want modern healthcare to be like (THOSE EIGHT BEDS AND SIX EXAMINING ROOMS ARE SO SCARY!) because of politics.

Also, nice attempt to use race by saying "segregated." If a "marvelous" comment is homophobic, then one could easily choose to read race-baiting into your words :)

prairie wind said...

Being treated in the emergency room is often the beginning of a slide for older patients: within three months of being sent home, up to 27 percent have another emergency, are admitted to the hospital or die, studies show.

I have been to the ER with my elderly mother-in-law more times than I can count and yes, ERs can and should do things differently. Especially for the elderly for whom confusion is something to be avoided, but why not for all patients? Why not non-slip floors for all patients and the staff, too? Why not soothing surroundings for the frightened 4-year-old as well as the grandparents?

When hospitals realized that the OB department was a money-maker (and a loyalty-builder), they started building elaborate, beautiful, comfortable suites for those patients. Shouldn't surprise us that the elderly get some attention, too, because elderly people use the ER more frequently and spend more money there than other age groups, so it makes sense that they get the pampering.

I'm waiting for the day when the Radiology department is given some money to warm up those metal tables.

EDH said...

Above them, an artificial sun shined through a skylight imprinted with a photographic rendering of a robin’s-egg-blue sky, puffy clouds and leafy trees.

I'm thinking a segregated emergency room for members of congress at Walter Reed Army Medical Center or Bethesda Naval Hospital with a floor in the motif of fire and brimstone, with devils and those caves and the ragged clothing! And the heat! My god, the heat!

traditionalguy said...

The Hospitals today are going big time into developing a separate expertise for professional comforting the dying and counseling them as they accept their fate and pass.

That is not health care at all. But since it is the new Government Funded flow of money, then it will soon be where professional careers are made for talented and flexible administrators, who will no longer go into medical care.

Eugenics of the Great Rulers: If they don't succeed in killing you before birth, then they get in their final shot at you when they prove who controls your death.

So there really is a war on women, and a war on men, and a war on any inconvenient age living person.

And no one can fight against the planned outcomes without private wealth. Ergo: the goal of the Eugenics Rulers is to transform the USA into an equally poor society. Redistribution which removes private wealth will seem fair, but it is a deadly trick.

jeffmacguy said...

I see how some commenters fixate on the pejorative term, "death panels".

Do you really believe that medical care will be unlimited? Anyone presenting with a little cough will get chest x-rays and an MRI to make sure they don't have lung cancer? Of course not, but there will be some protocol developed by some group of people to determine a standard treatment model.

Call them what you want. And their decisions will be more financial than medical. And that's just one of the problems I have with Obamacare.

Jane said...

Read "patients on Medicare" for "patients over 65" -- I didn't see anything death-panely about this, so my immediate thought was that there must be something about Medicare reimbursements going on here, some way in which they can bill them more for a more expensive ER visit, where your standard ER room may be full of the uninsured or Medicaid patients.

Pogo said...

It's a way to make money despite Medicare's rationed fees.

Mount Sinai has its rich and famous clientele (Gwyneth Paltrow gave birth there), unlike Elmhurst Hospital in Queens, where patient demographics include the homeless, immigrants and blue-collar workers.

Sinai has 3-room suites with views of Central Park for $4,000 per night. 30% of the clientele who use the pricey Eleven West wing are from abroad. From a NYTimes article in Jan 2012:

"The 19-room unit which opened 18 years ago but received a recent face-lift, takes in $3.5 million a year.

In Eleven West’s library on a recent Friday, Nancy Hemenway, a senior financial services executive, was reading the paper in a spa-style bathrobe. “I was supposed to be in Buenos Aires last week taking tango lessons, but unfortunately I hurt my back, so I’m here with my concierge,” she said.

“The one misgiving is patients with Medicare, which pays physicians almost nothing,” said Dr. Brian Katz, 59, a laparoscopic surgeon in scrubs who took a break in the same library later. “Yet those patients will come up here and pay to enjoy five-star comfort.
"


2.

hawkeyedjb said...

"Deciding who lives and who dies is the price of government run health care. Trying to value the lives of the old against the young is part of the challenge..."

But that's a challenge whether we have private or socialized health care, isn't it? We can bankrupt ourselves providing extraordinary care in the last year(s) of life under any payer-system. One of the reasons the USA spends so much more than other societies on health care is that we spend so much more on end-of-life care. Assuming resources are limited (and they are, not matter what we think), we truly are taking away from the young in order to extend the lives of those who have lived, in many cases, very long lives. Why should this be considered a more moral position? What's the dollare value of having your kids grow up around their grandparents, you ask? Well, if it's not your dollars, I guess it's unlimited. How about the value of my children getting better care at the expense of your 90-year old grandmother? Anyone who responds "we can do it all" isn't living in a real world. We can't devote our entire national economic output to health care, but that's what it will come to if we continue to assume that resources are unlimited for anything we call "health care."

prairie wind said...

hawkeyedjb, of course there are cost/benefit decisions to be made! The question is who makes those decisions...Medicare bureaucrats who never met your grandmother...or you and your grandmother?

machine said...

Jeff, Ms. Althouse brought up the Death Panel lie and Dan in Philly commented that it was "the price of government run health care"...hence the quotation marks.

And if it's one of "the problems I have with Obamacare", then you have problems with all health care.

Pogo said...

"Assuming resources are limited...
"

Bullshit.

"Resources" are always limited. No argument. The problem comes when you claim all resources for the collective.

Some old people have loads of money; their resources are not very limited at all.

What business is it of yours if they spend every last cent they have on health care?

David said...

Triage is an issue in all medical treatments. Where resources are limited, there is always a question of how to allocate the resources, and who is doing the allocation. Getting rid of Obamacare, which I think we should do, is not going to end this dilemma.

I simply lack confidence in the ability of government to set the standards for these decisions. At present the government is not really willing to acknowledge that the dilemma is inherent in their program, so how can they address it properly.

Moreover, the government will tend to a single set of rules applicable to all. That's a mistake too. Much better to let localities, whether governmental or private providers, work out their own solutions. We will have a diversity of solutions, some of which may be better than others. There may be a tendency for the solutions to conform to each other, or there may not. And the issue will be constantly complicated by medical innovation.

It ain't easy. But I want my death panel more accessible than bureaucrats in agencies in Washington.

Freder Frederson said...

There are stories out of the UK's NHS where 70ish early cancer patients are written off, only to go abroad for treatment or have their families pay cash, after which they have many years of healthy, happy, productive life.

Bullshit, just complete bullshit.

My father was diagnosed with cancer at the age of 79 under the NHS. He received excellent, prompt, extensive care and is now cancer free at the age of 81.

Scott M said...

Yes, Freder, but he had a gash in his head.

Matthew Sablan said...

Great anecdote.

AllieOop said...

Death Panels? You people really need to get a grip. As a nurse who has worked on an Alzheimer Dementia unit, I can tell you these patients injure themselves due to the level of confusion and get sent out to an ER quite often. Also being elderly they have a whole host of physical issues that gets them sent out to the ER more often than younger folks.

If you ever have been an ER nurse, you know how disruptive it can be to other patients to have a dementia patient screaming at the top of their lungs about something not real. They get triaged just like any other ER patient, then they get sent to the geriatric area.

They don't get shunted over to the pretty rooms to die. Many of these patients have a no code status already in place. Advanced directives have been used since long before Obamacare.

Kit said...

...been able to reduce unscheduled return visits to the emergency room to 1 percent of cases, from 20 percent.

This seems like a helpful innovation for both the patient and the general cost of healthcare.

MadisonMan said...

Hospitals can be clever at finding income streams. I'm always pleasantly surprised I don't see more advertisements when I'm in a facility.

If the Hospital can squeeze money out of the rich by pampering them, I say why not? It's the American Way. If you want that kind of treatment, work hard and make money so you can afford it.

I think it's a waste of money, but I'm cheap.

Pogo said...

"Advanced directives have been used since long before Obamacare."

True, but under Obamacare those decisions will be made for you.

Just like in the UK, where age is a large factor in whether you do or do not get access to certain care.

Moneyrunner said...

"No one really talks much about this during the whole health care debate, but these are the kinds of decisions you have to make as a society when you decide to go to a government run health care.

Who is this “society” that decides who lives and dies? Is there some entity at the reception desk of the hospital named “society” who shunts the elderly off to the room with the fluffy clouds and the nurses with the pain pills? I think we all know who “society” really is don’t we? It’s government bureaucrats who will tell the hospital staff who is to be cured and who is to be palliated. “Sure, we can cure your cancer but at your age, that’s a waste of ‘society’s resources.” “You say you have pneumonia? It’s the ‘old man’s friend’ go and die peacefully.”

What’s most disturbing about these expressions is that they are a not-so-faint echo of the way that the designation of “useless eaters” marked the most despicable culture of the last century. To have it taken up by that ideological segment of the political spectrum that proclaims that it’s for the poor and powerless gives an insight into the Liberal mindset.

This inevitable result of government control of healthcare is THE reason that ethical people must reject it. Let people and families make their own decisions about the extent they wish to fight against death. But let us not turn the process over to what – in a remarkable moment of truth-telling - were called Death Panels.

Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.

Though wise men at their end know dark is right,
Because their words had forked no lightning they
Do not go gentle into that good night.

Good men, the last wave by, crying how bright
Their frail deeds might have danced in a green bay,
Rage, rage against the dying of the light.

Wild men who caught and sang the sun in flight,
And learn, too late, they grieved it on its way,
Do not go gentle into that good night.

Grave men, near death, who see with blinding sight
Blind eyes could blaze like meteors and be gay,
Rage, rage against the dying of the light.

And you, my father, there on the sad height,
Curse, bless me now with your fierce tears, I pray.
Do not go gentle into that good night.
Rage, rage against the dying of the light.

Dylan Thomas

Peter said...

Given a choice between more funding for autistic children or denying hip replacements to those aged 70 or above, the autistic kids will win every time.

They'll win because they have a better lobby. And it doesn't much matter how effective the treatments for autistic kids are, or how much it costs- when government decides, it becomes a political question.

So, if you don't have enough QUALYs (Quality-Adjusted Life-Years) remaining, you can expect only palliative care.

We we just have to hope we don't reach the point of building euthanasia parlors to ease the last monemnts of those judged to be "useless eaters."

AllieOop said...

Pogo, how does Obamacare make the Advanced Directives decisions for a patient? Can you elaborate?

Pogo said...

I do agree with Althouse on this, however:

These segregated ERs may start out being a way to make money catering to rich old people, but they will be adopted eslewhere, to cut the costs of ER care for the elderly by providing fewer services to them.

Pogo said...

"Pogo, how does Obamacare make the Advanced Directives decisions for a patient?"

If you are over age X, you will not have the choice of whether or not you receive lifesaving treatment, such as placement in an ICU.

"There is a recognised shortage of intensive care beds in the UK for patients of all ages but
the proportion of patients on a general ward who should have been in intensive care increases with the age of the patient. An older trauma victim is much less likely than a younger patient to be transferred to intensive care.
source"

TOTWTYTR said...

Although I am a staunch opponent of Obamacare and hope that the law is struck down by the Supreme Court, I don't think this is part of that.

Rather it's a long overdue realization that geriatric medicine is different than "adult" medicine.

In EMS we are taught that children are not "just small adults", but have a number of major medical differences from grown ups.

The same appears to be true with the elderly. They don't feel pain the same way as younger adults do, they don't always present with the same symptoms when they are having heart attacks and other major medical problems either.

People are living longer, but more importantly, they are living healthier longer. As a result we seeing patients who are older than we used to and they are presenting us with new challenges in health care.

It's not uncommon for elderly patients without complicated medical histories to undergo surgery and procedures unthinkable ten years ago.

I think that the move towards separate ERs geared to geriatric patients is a logical progressions of medicine.

Just as there are Pediatricians, we are starting to see Geriatricians who specialize in treating the elderly.

We can all away our Aluminum Foil Deflector Beanies for now.

AllieOop said...

Pogo, last I looked we are living in the USofA. Obama care is based on Private Insurance, hospitals are still private under Obamacare.

Your source isn't the American model.

Pogo said...

Same article about the elderly in the UK:
"Older patients do not receive equivalent levels of end of life care to those received by younger patients. In part this is explained by the better end of life care received by cancer patients who are, on average, younger, but age appears to be an independent factor both in place of death and access to specialist care.

The high, and increasing, rates of hospital readmission within 28 days of hospital discharge, for older patients, is a clear indication of problems with the hospital care or discharge procedures for this group. This would appear to be a case of indirect discrimination, where universally applied policies are particularly disadvantageous to older people.

There is clear, multiple and widespread evidence of a reduction in the investigation and treatment of cancers with the increasing age of the patient. The link with age appears to be clear even when other factors such as comorbidity and tumour subsite are taken into account. The net result is that age specific mortality rates for older people dying from cancer are higher in the UK than in northern or western Europe or the USA.
"

Pogo said...

"Your source isn't the American model."

You're mistaken.

Obama's recess appointment Medicare chief Donald Berwick:
"“I fell in love with the NHS,” Berwick said in a 2008 speech of the system that he had worked on since the 1990s. “To an American observer, the NHS is such a seductress. … Like any lover, it took me a while to see the blemishes of my beloved, though I soon had help from people quite willing to point out the warts."

Earth Girl said...

Ann, how close are you to age 65? I'm 3 years from it and am definitely not elderly or end-of-life. Let's say I have a car accident in 3 years with severe but not critical injuries. I would be sent to the geriatric section based on their criteria:

they are over 65, know their name,
were able to walk before the day of the hospital visit and
are ranked 3, 4 or 5 on a standard emergency severity index of 1 to 5, with 1 being the sickest."

AllieOop said...
This comment has been removed by the author.
AllieOop said...

As a nurse who has had to tube feed geriatric dementia patients whose bodies could no longer digest even the mildest of liquid supplements and who were in a continuous state of discomfort and risk for aspiration due to reflux, chronic diarrhea, having to keep their hands out of their feces and mouths, keep their heads above their stomach level, when they are so weak they continually slide down in bed, because the families wanted to keep Mom or Dad alive way beyond the time that nature would kindly have taken them is beyond sad.

Prolonging life artificially can be cruel at times. Even before Obama care inserting G tubes for feeding of elderly dementia patients was on the decline, thank goodness.

Unless you have taken care of these patients with dementia and Alzheimer's, you simply have no idea. All the death panel talk is unrealistic and stuff of the aluminum foil hat society.

AllieOop said...

Earth Girl, what makes you think that they wouldn't ask you first? Also what makes you think you wouldn't prefer that unit? I would, I'd rather look at that pretty "window" than sit in a crowded ER waiting room. I'm 60 years old.

Kirk Parker said...

Pogo, when I do the math on the fancy unit at Sinai, it comes to $505/night/room. Better than Motel 6, but not exactly mind-boggling for NYC.

tim in vermont said...

"I mean, the chronically ill and those toward the end of their lives are accounting for potentially 80 percent of the total health care bill out here.

So how do you — how do we deal with it?

THE PRESIDENT: Well, I think that there is going to have to be a conversation that is guided by doctors, scientists, ethicists. And then there is going to have to be a very difficult democratic conversation that takes place. It is very difficult to imagine the country making those decisions just through the normal political channels. And that’s part of why you have to have some independent group that can give you guidance. It’s not determinative, but I think has to be able to give you some guidance. And that’s part of what I suspect you’ll see emerging out of the various health care conversations that are taking place on the Hill right now." -- Obama 2009

http://www.nytimes.com/2009/05/03/magazine/03Obama-t.html?_r=1&partner=rss&emc=rss&pagewanted=all

I can't imagine where people got the ideas about death panels...

I can't imagine

hawkeyedjb said...

"What business is it of yours if they spend every last cent they have on health care?"

None.

But what if they want to spend every last cent I have? Or every last cent the insurance company has? It's very, very rare that a person is spending his/her own money on end-of-life care. My wife is a nurse and has seen too many examples of a family requesting heroic measures to keep Uncle Milton alive for a little while longer, and the cost is certainly not coming out of their pocket (or Uncle Milton's).

tim in vermont said...

What is sort of ironic too is that the Admin has said they wanted to focus like a laser beam on jobs, and yet, they don't want to allow people to choose to spend money on medical care, thus creating jobs that are difficult to export. These jobs are better than flipping hamburgers for each other.

tim in vermont said...

"But what if they want to spend every last cent I have?"

It doesn't seem to trouble Democrats too much if "they" want to spend every last cent I have on inflated pensions for public employees...

Old people just don't vote Democrat the way they used to, so under the bus with them.

Moneyrunner said...

AllieOop,

Your comments make it all the more obvious that you approve of what Death Panels would do to the patients you would rather not have to treat. Your argument seems to be with the label. I can understand wanting to change the term for the way you would like to see the Alzheimer’s patient s euthanized. The Dutch already do it. And it turns out that the reason to euthanize people gets pretty slippery pretty fast. “We don’t need no stinkin’ useless eaters.”

AllieOop said...

Old people who must be kept alive artificially don't vote. It would be pretty difficult task getting them to the polls or filling out any kind of forms.

So they would not be capable of voting for ether party, if they even knew what a party, politics or voting was anymore.

AllieOop said...

Money runner, death panels are the stuff of your nightmares, they are not real. Have you ever had a family member admitted to a nursing home in the last 25 years?

One of the first things that will be done is get an Advanced Directive and code status, which is up to the patient and their health care power of attorney and doctor.

Pogo said...

"Unless you have taken care of these patients with dementia and Alzheimer's, you simply have no idea."

As a geriatrician, I have worked in hospitals, ERs, nursing homes, and hospices.

My grandparents and parents and in-laws have all had difficult aging, as you describe.

I believe I have an idea.
And I came to different conclusions than you did.

Freder Frederson said...

The question is who makes those decisions...Medicare bureaucrats who never met your grandmother...or you and your grandmother?

don't you mean you and your grandmother, her insurance company and bank? If government isn't involved in healthcare, then health care decisions will be based entirely on ability to pay. Either way you have bureaucrats making healthcare decisions for you.

Basing life and death decisions strictly on ability to pay is more immoral than anything the government can dream up.

tim in vermont said...

Stuff of our nightmares and Obama's dreams.

See the Obama quote above.

As soon as the govt is in charge of these decisions, they are political.

So breast cancer is a high priority, where they even have their own high speed clinics in Canada, and prostate cancer? Well not so much... better not to do the tests and leave it to nature...

Just because some people make poor end of life decisions is not grounds to control everybody's end of life treatment.

tim in vermont said...

I meant to add that the reason politicians put such high priority on women's health issues is, as you no doubt know, alieoop, that nursing homes are packed to the gills with elderly men left alone becuase their wives pre-deceased them due to the health care war on women.

Matthew Sablan said...

"Basing life and death decisions strictly on ability to pay is more immoral than anything the government can dream up."

-- The government can layer ability to pay with political calculations. If you add in the government, we do not suddenly get loads more money for everybody to spend. You still get the government turning down Medicare/Medicaid patients at similar (or higher!) rates than private insurance; people still die for want of doctors and beds. You don't increase supply of care by regulating it. Adding barriers to entry does not make it more likely more people will get care.

AllieOop said...

Pogo, are you one of those doctors that orders an IV for a dementia patient because of dehydration?

You as a physician and Geriatrician may know of what I speak, but are you on the unit caring for these patients? Or do you just waltz in, write orders, go play some golf, and get PO'd when you get paged when the patient has ripped out their peg tube, or the IV has infiltrated and a new site can't be found?

Not accusing you of this, just wondering. Because docs like that have a reputation on dementia units that I won't describe.

Matthew Sablan said...

Hey, that goal post? Did it just move?

Scott M said...

Hey, that goal post? Did it just move?

And just how heavy are those posts?

Pogo said...

"Not accusing you of this, just wondering."

Of course you are accusing me.
And I find that a sickening tactic.


"Or do you just waltz in, write orders, go play some golf..."
I work 11-12 hours a day, which leaves little room for golf. In fact, I have only played twice in the past 5 years.

What a small, petty comment.

AllieOop said...

Another aspect to this discussion to think about? Do any of you realize what a huge Industry hospice care is? Do you realize that doctors have been ordering pain meds to dying patients for the last 20 years in doses that would and does hasten death? Way before Obamacare.

Ok so now freak out.

AllieOop said...

Pogo, yes, yes doctors are the heros , I forgot to be the good little nursey. Nurses don't do anything remotely difficult or heroic, now do they?

AllieOop said...

BTW Pogo, my husband was a Pediatrician.

MadisonMan said...

What a small, petty comment.

I agree. Not a nice comment to read, and it wasn't even directed at me.

Matthew Sablan said...

Just because something is always done doesn't mean it should always be done. Make the case why this is a good thing, not just: "Well, we've always done it, so hey, let's do it still. But more expensively."

Pogo said...

"yes, yes doctors are the heros , I forgot to be the good little nursey. "

I think there is a middle ground between reflexive animosity and smarminess.

How about we treat each other as intelligent adults?

edutcher said...

Ann says, "Death panels", and all of Dr Goebbels' minions come out of the woodwork with, "No, no, you're just being resettled in the East".

If your doctor is tall, blond, has a lean, sharp face with an aquiline nose, and answers to, "Reinhard", you're in trouble.

If your doctor is medium height, dark, has a round, plump face, and has a tag that says, "Hi, I'm Dr Mengele", take as many with you as you can.

PS Wasn't it Dr Berwick who said he just loved Britain's NHS?

The Blonde got plenty of people from Britain who'd saved up to come here to get good care and would ask, "Why in the world are you getting rid of the best care in the world?".

AllieOop said...
This comment has been removed by the author.
AllieOop said...

Pogo, if you want to deny there are docs out there who do just as I described, fine. I'm glad you aren't one of those docs, I believe you.

I know plenty of docs socially, I know many of them are concerned about the financial ramifications of Obamacare. I can understand that concern.

I've stated before on this blog that I don't like Obamacare and would be relieved to see the SC ruling come down as it being unconstitutional.

But maybe not for any fear of death panels, because they don't exist.

Bender said...

With advance directives, it is NOT the patient who makes the ultimate decisions, it is the "healthcare" provider who makes the decisions because it is the provider who interprets the AD. And all too often, the provider is going to interpret the AD against the provision of care. All too often, the provider looks at the AD as a one-way street, if they bother to read the damn thing at all.

If you really want to protect the decisions of the patient, that can only be done with a healthcare power of attorney to someone the patient trusts, a family member, and not some culture-of-death doctor or geriatric nurse who uses the name of an ape as her handle (appropriate fit there).
_____________________

Food is not medical care. And the provision of food and water by a particular method is not any more or less "artificial" than it is artificial to get your food that has been artifically transported to a grocery, where you artificially transport it to your home and artificially cook it before artifically using a fork to stick it in your mouth or a straw to suck in your drink.

But we see here the mentality of those who we hand our lives over too for care and protection -- quick to label things as "burdensome" and "prolonging life artificially" and "needlessly cruel" so as to justify their idea of mercy, which is the equivilent of bashing the patient's head in with a brick.

No, the culture of death did not begin with ObamaCare, it began long before (although it did have a bit of a respite between 1945 and the 70s) and it will continue to be a cancer on society for years to come.

Susan Schneider said...

For the last 5 months I have been involved in my 91 year old aunt's health care in Orange County, CA.

These are my conclusions:1)There is not enough coordination among her primary care physician (who is also a gerontologist) and the emergency room staff and hospital thereafter. I thought electronic records were in place, accessible and should be consulted. 2) Emergency rooms and hospital care thereafter do not seem educated in the care of the elderly 3) They overmedicate and create near-death episodes of extended periods of unresponsiveness that may take days to overcome. 4) They particularly overmedicate with pain-killers. 5) Hospice should be more flexible when a person has a will-to-live and is able to recover with appropriate preventive testing of eg. the need for simple antibiotics. 6) The advance directive while valuable should not be a method of rushing into withdrawal of simple treatments. 6) Elderly individuals serve the function in our society of reminding us what really matters in life.

Bender said...

Do you realize that doctors have been ordering pain meds to dying patients for the last 20 years in doses that would and does hasten death?

Yes, we know about the medicalized murder that has been going on for years, we know about how too many places dedicated to saving lives are actually death traps mirroring Hadamar.

Bender said...

And more and more we see "healthcare" providers going into court to override the medical decisions of patients and their families to give the providers a death warrant to terminate the patient.

Yes, with or without ObamaCare, medicalized death is a reality.

AllieOop said...

Bender, the healthcare power of attorney in almost every instance is a family member. The nurse has no say in this and the doctor follows the direction of the family member, who as I said is almost always the HC POA.

Nice try, but fail.

Bender said...

There is a difference between an advance directive and a healthcare power of attorney. But you already know that. So don't try here to equate the two.

Most people do not, in fact, have a healthcare power of attorney. They only have an advance directive (a living will). And the mere existence of an advance directive, regardless of its terms which few bother to read, is enough for many to simply assume that it pertains to the withholding of care.

Pogo said...

"Pogo, if you want to deny there are docs out there who do just as I described, fine."

When did I...

Oh, the hell with it. Sheesh.

AllieOop said...

Wrong. Bender, the minute a geriatric patient gets admitted to a nursing home or hospital a social worker visits them to set up a HC POA. Then the docs are called and orders are obtained for code staus as well as other orders.

I don't know where your information is coming from, I hope you're not an attorney or a physician.

AllieOop said...

Pogo, sorry I know you didn't.

Bender said...

If your doctor is medium height, dark, has a round, plump face, and has a tag that says, "Hi, I'm Dr Mengele", take as many with you as you can.

edutcher, the right historical parallel is Dr. Karl Brandt, who oversaw the various medicalized death programs in Germany in the 1930s and 40s, not Mengele.

See, U.S. vs. Dr. Karl Brandt, et al. (the Medical Case), Nuremberg Military Tribunals Case 1

There was also U.S. v. Dr. Alfons Klein, et al. (the Hadamar Trial), focusing on the Hadamar sanatorium, where thousands were provided the "merciful release" of a medical death.

Bender said...

Well one would hope that you would not be a healthcare withholder, I mean, provider, but apparently you are, Nurse of Death.

AllieOop said...

Bender, you are an idiot. How many lives have you saved lately?

Bender said...

As for executing an advance directive, or a healthcare power of attorney, or a combination advance directive with a POA included, the presence of a social worker or anyone else associated with a healthcare facility is not only unwarranted, but is highly suspect and quite likely to result in undue influence upon the patient, such that it is not a freely made choice.

Indeed, most fill-in-the-blank ADs slant toward the withholding of care, not the provision of care. That is not surprising since living wills grew out of the "right to die" movement. So it is not all that surprising that the death nurse who raised them here would spend so much time talking about morphine overdoses and starving/dehydrating people to death as if those were good things.

edutcher said...

Bender said...

If your doctor is medium height, dark, has a round, plump face, and has a tag that says, "Hi, I'm Dr Mengele", take as many with you as you can.

edutcher, the right historical parallel is Dr. Karl Brandt, who oversaw the various medicalized death programs in Germany in the 1930s and 40s, not Mengele.


Probably right, but I figure, like the sterilization programs in the Reich, when people find out what's going on, they'll have to forego the middle men and send everybody to Buchenwald-on-the-Gallatin.

PS Bender, you and I have probably saved more lives than Oop. She's the recycled Mitochondri, Apfelkuchen, and who knows who all else.

AllieOop said...

Bender, I wish for you a long long life, they endof it spent in a nursing home, getting those yummy tube feelings, playing with your feces and breathing gastric contents.That bellyache isn't so bad is it?

Everyone would choose such a wonderful ending to their lives, would they not?

AllieOop said...

Eddutcher, I don't believe you really exist, you are merely a sychophant resident computer program here at Althouse.

How many have you put on your enemies list now? are you ready to start your shooting war against Democrats and liberals yet?

edutcher said...

When did I say I had an enemies list? I just called your side out for its ultimate goals.

And your side's doing all the shooting (and beating and raping) these days.

AllieOop said...

Bender, I wish for you a long long life, they endof it spent in a nursing home, getting those yummy tube feelings, playing with your feces and breathing gastric contents

She's such a pleasant personality, isn't she?

AllieOop said...

Eddutcher, you don't call Bender on his Nurse of Death comment, typical Edutcher. Make sure you too spell out clearly in your Advanced Directives that you want those yummy tube feelings.

Alex said...

So now we're clear - Obama is Hitler, Michelle is Eva Braun and Eric Holder is Himmler.

edutcher said...

AllieOop said...

Eddutcher, you don't call Bender on his Nurse of Death comment, typical Edutcher. Make sure you too spell out clearly in your Advanced Directives that you want those yummy tube feelings.

Sweetie, my wife is a nurse, currently helping her best bud, who's a nurse, take care of her sister after a stroke with just the problems you mention.

In addition, two of her sisters-in-law are nurses, as is my sister.

I have never heard any of them wish the kind of life on anyone you have. So we have our typical, compassionate, tolerant Lefty, wishing ill on all those that dispute her.

Honey, if you ever nursed anywhere, the supervisor was Ilsa Koch.

AllieOop said...
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AllieOop said...

Good lord Ed, you must live a very sheltered life, nurses come in all sizes, shapes, colors, religions, personalities and political persuasions. One size does not fit all.

You too are on my ignore list here, it's growing, the stupidity is astounding.

tim in vermont said...

"No, the culture of death did not begin with ObamaCare, it began long before (although it did have a bit of a respite between 1945 and the 70s) and it will continue to be a cancer on society for years to come."

This comment brings up a good point. WWII was the biggest, most important, comprehensive insight into the dangerous possiblities of human nature that are possible offered by the last century, and we are not allowed to talk about it...

tim in vermont said...

AllieOop
Usually, when one party to a discussion is astounded by the other's stupidity, it is because the austounded party refuses to examine the other's argument in any depth. It is a learning opportunity lost, but whatever.

Reject first, ask rhetorical questions later, it is the path to true understanding.

edutcher said...

AllieOop said...

Good lord Ed, you must live a very sheltered life, nurses come in all sizes, shapes, colors, religions, personalities and political persuasions. One size does not fit all.

This includes compassion and empathy in your case, I take it.

Moneyrunner said...

AllieOop I see you are retired. I'm glad.

Freder Frederson said...

although it did have a bit of a respite between 1945 and the 70s

You mean in the period when we fought two meaningless wars that cost almost 100,000 American lives (and countless lesser ones). Not to mention the constant threat of nuclear annihilation.

Freder Frederson said...

And your side's doing all the shooting (and beating and raping) these days.

And we'll just pretend that two guys in Tulsa didn't get arrested for randomly shooting five black people (killing three).

AllieOop said...
This comment has been removed by the author.
Scott M said...

And we'll just pretend that two guys in Tulsa didn't get arrested for randomly shooting five black people (killing three).

Two guys does not a flash mob nor a knockout gang make.

AllieOop said...

Moneyrunner, that says it all. You would have been lucky to have me as your nurse. I gave a damn.

edutcher said...

Freder Frederson said...

although it did have a bit of a respite between 1945 and the 70s

You mean in the period when we fought two meaningless wars that cost almost 100,000 American lives (and countless lesser ones). Not to mention the constant threat of nuclear annihilation.


How dare we defy Glorious World Socialist Revolution?

And we'll just pretend that two guys in Tulsa didn't get arrested for randomly shooting five black people (killing three).

Freder's pretending the beatings in Baltimore and Toledo and shooting up a cop car in Sanford didn't really happen.

edutcher said...

AllieOop said...

Moneyrunner, that says it all. You would have been lucky to have me as your nurse. I gave a damn.

But, given her comments, not about her patients.

galdosiana said...
This comment has been removed by the author.
Freder Frederson said...

Freder's pretending the beatings in Baltimore and Toledo and shooting up a cop car in Sanford didn't really happen.

I never claimed that "your side's doing all the shooting (and beating and raping) these days."

edutcher said...

Just the 99% of it.

leslyn said...

I don't know how this thread got to where it is, and I don't care.

What I like is Althouse's question about red flags and "death panels.

Yes, that's wrong, at least according to the people in the article, and the patients, who I presume are sincere:

“They thought it was a bedpan unit, focused on nursing home patients,” Dr. Rosenberg said [about doctors and nurses]. “When they finally realized this was the unit that gave better health care to their parents and grandparents, they jumped onboard.”

"....At Mount Sinai, all arrivals go through triage in the regular emergency department and are sent to the geriatric department if they are over 65, know their name, were able to walk before the day of the hospital visit and are ranked 3, 4 or 5 on a standard emergency severity index of 1 to 5, with 1 being the sickest. Someone with a broken hip would probably qualify, but someone with an acute heart attack would most likely have to be stabilized in the regular emergency room first, said Dr. Kevin M. Baumlin, the vice chairman of emergency medicine, who founded the geriatric emergency room."

When I get old enough to qualify, I hope I have access to such care.

Robert Cook said...

I have been hospitalized "twice," (I put quotes around that because the first time I had leukemia and was in for a week, out for a week, in for two and a half weeks, out for 3 or 4 days, and in again finally for 4 days...the second time, 10 years later, I had pneumonia and was in for 3 days), "both" times at Mt. Sinai in Manhattan. I have to commend and compliment them--mainly the nurses--for their wonderful care.

Most of the patients I saw around me were not wealthy but were workaday New Yorkers. I sat in the basement one evening during my first stay, awaiting an x-ray, and I looked around at the array of other ill people waiting for their x-rays--people young and old, poor and affluent--and it hit me that we all eventually belong to the kingdom of the ill, and none of us escapes this brother- or sisterhood, however long we may successfully outrun it.

Fortunately, I have pretty good insurance through my job--but many people are not so fortunate. It struck me then how unjust it was that the care one received, or not, and one's fate--life or death, health or enfeeblement--depended on one's good fortune in being able to afford care or in having a job that provided good insurance.

I will always be a proponent of single-payer medical care as a result of my experience.

I don't know AllieOop's views on that, but I say "bravo!" to her for effective dealing with some of the more brutish of the commenters here.

Seeing Red said...

Those facilities are not fair. That's what it ultimately comes down to. If the poor can't have those facilities, neither should the rich.

Seeing Red said...

Yet, Cookie, your vision gives all of us poorer care in the long run.

Do you read the Canadian papers? Or the British?

jeff said...

"And we'll just pretend that two guys in Tulsa didn't get arrested for randomly shooting five black people (killing three)."

I was unaware they released the political orientation of the shooters.

Where did you find this information?

What most people are probably worried about is medical care for quality of life. My mother had two knee transplants in the years before her death. They provided a quality that was most helpful to her. Both her and my father had DNRs for most medical issues. The question is what sort medical procedures will be available when the rationing begins? I don't think that is an invalid concern.

AllieOop said...
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AllieOop said...

Jeff, I'm curious, when you and your parents decided on the DNR status, were you in an way coerced by nurses or the MD, or a social worker?

jeff said...

AllieOop- Oh no. Both my parents enjoyed life, and had no interest in a life extended via machinery or drugs. Neither had any interest at all at being warehoused simply to not die. It was a quality of life decision for them.

AllieOop said...

Thanks for answering my question Jeff, I'm glad your parents were able to relay their wishes and have then followed.

leslyn said...

Seeing Red said...
Those facilities are not fair. That's what it ultimately comes down to. If the poor can't have those facilities, neither should the rich.

4/10/12 4:36 PM

Red, did you even read the article? Here's the first graph:

"Phyllis Spielberger, a retired hat seller at Bendel’s, picked at a plastic dish of beets and corn as her husband, Jason, sat at the foot of her hospital bed, telling her to eat."

A retired hat seller at Bendel's. Doesn't sound like a rich person to me. Didn't look like one in the picture (whatever one looks like). If you get picked up by an ambulance, you have the choice to go to the hospital with the geriatic emergency room, if time and circumstances permit. In other words, no one is favoring the rich, and the comment was just stupid.

Cynthia Yockey said...

Ann, the geriatric ER's seem like a legitimate effort to ensure better care for a specific target market: the subgroup of the elderly who are vulnerable to being injured by the traditional ER. One size does not fit all. They are evaluating each patient and those who have to be immediately stabilized are tracked to the traditional ER, which is why this does not seem like a death panel issue to me. They are addressing the fact that the traditional ER actually does put the less-acutely ill elderly at risk for totally preventable injury or death. Preventing sundowning, preventing falls and preventing pressure sores are all necessary for this population. It's compassionate, smart and cost-effective. I'm especially tickled that they are finally recognizing that ER's have patients at risk for pressure sores. My late life partner was quadriplegic due to MS the last 10 years of her life. When I had to take her to the ER, I had to work very hard to get her put onto a pressure-relieving mattress to prevent pressure sores. They would have to bring in a regular hospital bed. She once spent almost two days in the ER waiting for a space to open up so she could be admitted, an experience that I believe is still common. Pressure sores can develop in just two hours and the wound care to heal them gets expensive very fast -- it's best to prevent to prevent them. So amenities like the pressure-relieving mattresses and better design to prevent falls and sundowning all will prevent unnecessary suffering -- and will save a lot of money in the bargain.

Dan in Philly said...

"machine said...
Jeff, Ms. Althouse brought up the Death Panel lie and Dan in Philly commented that it was "the price of government run health care"...hence the quotation marks.

And if it's one of "the problems I have with Obamacare", then you have problems with all health care.

4/10/12 8:24 AM"

Sir, all health care is rationed, since there is an unlimited demand of it and a limited supply. The only question is what determines the limits. If you're ok with the state determining who receives health care and who does not, then you're ok with the implications, which are clearly that the state gets to decide who lives and who dies.

I am a bit more leary of ceeding such power to the state, but I understand the appeal. I just worry about the consequenses down the road - what if a hostile power controls the government? Will they use their power of delegating health care in ways which harm me and my loved ones? Will they use it to consolidate their own power and stifle public debate? Will they starve health care to minorities? Will they overspend on eye surgeries and thereby limit the number of OBGYN doctors through simple incmpetence?

This last problem is the biggest - many many years of history seems to indicate when you have government doling out resources they tend to make really big economic mistakes for political reasons, which leads to a results like too many eye doctors and not enough OB-GYNs. The free market tends to allocate resources much more effeciently, but if you anti-free market (and I understand the arguments against it), then you would probably embrace the problems of government run health care as a feature, not a bug. :)