Sunday, January 9, 2011

Death Panels Resurrected? Medicare Pays for End-of-Life Consultation

I’m blogging again while aboard an airplane. Continental demonstrated an effective strategy for bestowing a small measure of comfort onto its beleaguered passengers. The flight was on a one hour delay. Of course, time is an elastic concept to the airline industry. One hour can morph and expand into several hours. The most frustrating aspect for passengers is that we cannot rely upon the latest update to be a firm commitment. It is a modern day recreation of the Sisyphus myth, recalling the king who spends eternity pushing a boulder up a mountain, but never reaching the summit.

Are the death panels back? You remember this distortion from the political right who claimed that coverage for discussions of end-of-life care would soon lead to pulling the plug on granny? This provision was excised from the president’s health care plan, but has been resurrected by executive regulation at the end of 2010. The president has demonstrated that if you can’t get it by legislation, then grab it by regulation. Now, Medicare will reimburse physicians to advise patients on various end-of-life medical care options.

I support this policy. Of course, the time to discuss end-of-life issues is before the end of life. Without such discussions, patients and families do not make optimal and rational medical decisions. Understandably, during these times, they are not thinking clearly and are influenced by guilt, false hopes, pressure from friends and other family members and confusion about what is truly in the ill person’s best interest. Families may focus on trivial clinical events, which will not affect the outcome. I know this because I’ve been there. “Look, I think that his toe moved!” This process is made more agonizing since we physicians are rarely certain of anything, and medical miracles have occurred.

With advanced planning and discussion, folks can decide on the boundaries of their medical care and treatment. My primary reason for supporting this policy is on the medical merits. It will save patients from invasive, toxic and futile care that won’t add much time or meaning to their lives. Of course, it will also save a fortune in health care dollars, but this is not my primary objective.

Let the record show that I do not reflexively carry water for the political right, as I have been accused. I recently received the following comment from an op-ed piece published in our Cleveland newspaper. I offer excerpts of the kind and gentle comment below, for your amusement.

Did a Google serach (sic) for Michael Kirsch, M.D. -I suppose he is the second in the list (Michael Kirsch, MD Gastroenterologist in Cleveland, OH).
He has his own blog called "MD Whistleblower" where ALL he does is trash Obama and "Obamacare".
You are right. I can't believe the [Cleveland newspaper] would even publish articles by someone like this. He's got the credibility of Glenn Beck.
The title of his latest blog tells it all...
Sunday, December 26, 2010 - Obamacare Unconstitutional!
The second anyone refers to The Affordable Care Act of 2010 as "Obamacare" in an article you know what you're about to hear. Republican spin. He wastes no time - puts it right in the title. It might attract "his people" but it should be a turnoff to anyone else reading who has a mind of their own. I don't even bother reading such garbage.
More proof that he's another Rand Paul "less government in my life" libertarian nutjob (even when it comes to certification of doctors)...
SUNDAY, APRIL 18, 2010 - Does Board Certification Really Matter?
... and a believer of faith healing...
Sunday, September 19, 2010 - The Healing Power of Prayer: Faith vs Reason?
And he's got various other typical wingnut rants on everything from tort reform to EIGHTEEN different blogs ranting about the evils of healthcare reform.
NICE JOB - Keep your readers "informed" by the "professionals". Professional wingnut teabaggers that is. LOL!
Well, not everyone is a Whistleblower fan. But, sometimes the labels we assign to folks are wrong. Very few of us can be neatly categorized as liberal or conservative. Personally, I regard myself as a political moderate, although my views on Obamacare have given some the impression that I must be a Sarah Palin devotee. Do I think that Sarah Palin has been grossly underestimated? ‘You betcha!’ (Insert ‘wink’ here.) Do I think she has a political future? She will be a potent force, but she will never be a candidate for high office, in my view.

No, I don't regard the president's regulation permitting end-of-life discussion to be a 'Death Panel'. I'd call it a Life Panel.

Addendum:  The president performs a backflip on this issue!


  1. I would argue that most physicians are ill-equipped to deal with end-of-life issues in a way that is deserving of reimbursement.

  2. I would have to very much disagree, e-doc. While it's true that your ophthalmologist, orthopedic surgeon, or radiologist might not be well equipped, certainly PCPs, oncologists, hospitalists, intensivists, etc have all dealt with their fair share of end-of-life issues. What other professional else can accurately describe to patients what end of life care is like, how likely it is to help them, or what kind of suffering it might cause?

  3. How can you say that doctors are equipped with end-of-life issues when they do not even heal their prime-of-life patients?