Why are doctors operating, needlessly and so often, on frail seniors?

frail-300x150Although patient advocates long have pressed Big Medicine to eliminate unnecessary care — waste in the health care system that some experts estimate adds as much as $765 billion annually in needless costs — it may be past due for a public condemnation of a notably extreme example of this practice: The all too frequent, unhelpful surgeries for the old, many of whom are at the end of life.

Liz Szabo of the independent, nonprofit Kaiser Health News Service, and National Public Radio deserve credit for their report, detailing how 1 in 3 Medicare patients undergoes a serious procedure, “even though the evidence shows that many are more likely to be harmed than to benefit from it.”

As the story explains:

The practice is driven by financial incentives that reward doctors for doing procedures, as well as a medical culture in which patients and doctors are reluctant to talk about how surgical interventions should be prescribed more judiciously.

The late-in-life procedures for seniors, “rarely helps them live longer or returns the quality of life they once enjoyed,” research has shown. Instead, it too often degrades the lives of the affected patients, as “Older patients who undergo surgery within a year of death spent 50 percent more time in the hospital than others, and nearly twice as many days in intensive care. And while some robust octogenarians have many years ahead of them, studies show that surgery is also common among those who are far more frail.”

Elderly patients, many of whom grew up at a time when it was unacceptable to challenge doctors because of their education and standing, may spend precious weeks or months of the limited time they have left to live recuperating, slowly and painfully, from procedures. They often fare poorly with anesthesia and aggressive and invasive surgeries. It is impossible, of course, to determine exactly how close a patient may be to life’s end.

Still, doctors, sometimes overriding their patients documented wishes — as in their advance directives and do-not-resuscitate (DNR) orders — push easily confused, tired, and ailing seniors who clearly at fading in life for a range of procedures, including aggressive treatments of non-fatal skin cancers, and, more notably, defibrillators.

As Szabo reported of the heart resuscitation devices:

 More than 12 percent of defibrillators were implanted in people older than 80, according to a 2015 study. Doctors implant about 158,000 of the devices each year, according to the American College of Cardiology. The total cost of the procedure runs about $60,000.

In my practice, I see not only the significant harms that patients suffer while seeking medical services, but also that some of the most troubling injuries that can occur to the vulnerable old such as through nursing home abuse and neglect. I

It is problematic if caregivers violate adult patients’ informed consent. This is one of the most fundamental and important rights in medical care. It is the duty of anyone who provides any kind of medical treatment to provide the full, appropriate information so all of us can use our right to decide what happens to our own bodies. Providing this critical information isn’t easy to ensure with patients who may not hear or see well or who may have some cognitive impairment.

But Szabo notes in her story that some hospitals have developed resources and tools that go that extra step to disclose for patients what will happen to them in procedures. When they grasp this information, some decline surgeries because they realize they won’t benefit and may be harmed by them. This is a good thing.

Szabo’s story points out that seniors may go ahead with procedures, partly because they know Medicaid and Medicare will cover their cost. That’s a problem for the rest of us, though, if we’re paying for unneeded, wasteful, and harmful procedures, even as partisan extremists are attacking social safety net programs and trying to slash their funding. For all our sakes, let’s see if we can improve seniors’ lives — and save money — by eliminating needless procedures before we hack away at vital Medicaid and Medicaid funding and programs.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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