Announcement

Collapse
No announcement yet.

Health Care in US: a family's perspective

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • Health Care in US: a family's perspective

    Really an excellent and poignant piece:

    http://www.nytimes.com/2010/06/20/ma...omepage&src=me

    What Broke My Father’s Heart

    Eugene Richards for The New York Times
    The Connecticut home of the author's parents. The photo on the wall is of her parents as a young couple.

    By KATY BUTLER

    Published: June 14, 2010

    One October afternoon three years ago while I was visiting my parents, my mother made a request I dreaded and longed to fulfill. She had just poured me a cup of Earl Grey from her Japanese iron teapot, shaped like a little pumpkin; outside, two cardinals splashed in the birdbath in the weak Connecticut sunlight. Her white hair was gathered at the nape of her neck, and her voice was low. “Please help me get Jeff’s pacemaker turned off,” she said, using my father’s first name. I nodded, and my heart knocked.

    Enlarge This Image

    Eugene Richards for The New York Times

    Katy Butler sorting through her parents’ belongings after their deaths.



    Upstairs, my 85-year-old father, Jeffrey, a retired Wesleyan University professor who suffered from dementia, lay napping in what was once their shared bedroom. Sewn into a hump of skin and muscle below his right clavicle was the pacemaker that helped his heart outlive his brain. The size of a pocket watch, it had kept his heart beating rhythmically for nearly five years. Its battery was expected to last five more.
    After tea, I knew, my mother would help him from his narrow bed with its mattress encased in waterproof plastic. She would take him to the toilet, change his diaper and lead him tottering to the couch, where he would sit mutely for hours, pretending to read Joyce Carol Oates, the book falling in his lap as he stared out the window.
    I don’t like describing what dementia did to my father — and indirectly to my mother — without telling you first that my parents loved each other, and I loved them. That my mother, Valerie, could stain a deck and sew an evening dress from a photo in Vogue and thought of my father as her best friend. That my father had never given up easily on anything.
    Born in South Africa, he lost his left arm in World War II, but built floor-to-ceiling bookcases for our living room; earned a Ph.D. from Oxford; coached rugby; and with my two brothers as crew, sailed his beloved Rhodes 19 on Long Island Sound. When I was a child, he woke me, chortling, with his gloss on a verse from “The Rubaiyat of Omar Khayyam”: “Awake, my little one! Before life’s liquor in its cup be dry!” At bedtime he tucked me in, quoting “Hamlet” : “May flights of angels sing thee to thy rest!”
    Now I would look at him and think of Anton Chekhov, who died of tuberculosis in 1904. “Whenever there is someone in a family who has long been ill, and hopelessly ill,” he wrote, “there come painful moments when all timidly, secretly, at the bottom of their hearts long for his death.” A century later, my mother and I had come to long for the machine in my father’s chest to fail.
    Until 2001, my two brothers and I — all living in California — assumed that our parents would enjoy long, robust old ages capped by some brief, undefined final illness. Thanks to their own healthful habits and a panoply of medical advances — vaccines, antibiotics, airport defibrillators, 911 networks and the like — they weren’t likely to die prematurely of the pneumonias, influenzas and heart attacks that decimated previous generations. They walked every day. My mother practiced yoga. My father was writing a history of his birthplace, a small South African town.
    In short, they were seemingly among the lucky ones for whom the American medical system, despite its fragmentation, inequity and waste, works quite well. Medicare and supplemental insurance paid for their specialists and their trusted Middletown internist, the lean, bespectacled Robert Fales, who, like them, was skeptical of medical overdoing. “I bonded with your parents, and you don’t bond with everybody,” he once told me. “It’s easier to understand someone if they just tell it like it is from their heart and their soul.”
    They were also stoics and religious agnostics. They signed living wills and durable power-of-attorney documents for health care. My mother, who watched friends die slowly of cancer, had an underlined copy of the Hemlock Society’s “Final Exit” in her bookcase. Even so, I watched them lose control of their lives to a set of perverse financial incentives — for cardiologists, hospitals and especially the manufacturers of advanced medical devices — skewed to promote maximum treatment. At a point hard to precisely define, they stopped being beneficiaries of the war on sudden death and became its victims.

  • #2
    Re: Health Care in US: a family's perspective

    Concur. Thanks for posting.

    Comment


    • #3
      Re: Health Care in US: a family's perspective

      Originally posted by Jay View Post
      I watched them lose control of their lives to a set of perverse financial incentives — for cardiologists, hospitals and especially the manufacturers of advanced medical devices — skewed to promote maximum treatment.
      Jay,

      A hypothetical question -

      As a medical professional, what would you do, if there was a inexpensive simple treatment that prevented the symptomatic ravages of old age, however if widely adopted, would reduce your real income substantially?

      I know about the "hippocratic oath" which sometimes in real life becomes the "hypocritical" oath.
      Last edited by Rajiv; June 21, 2010, 03:34 PM.

      Comment


      • #4
        Re: Health Care in US: a family's perspective

        "I know about the "Hippocratic Oath" which sometimes in real life becomes the "hypocritical" oath."

        Yes indeed; and it's NOT all about money and maximizing procedures and profits.

        Original Oath of Hippocrates, translated into English

        I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath and agreement:

        To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art.

        I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.

        I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.

        But I will preserve the purity of my life and my arts.

        I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.

        In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.
        All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.

        If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot."


        Comment


        • #5
          Re: Health Care in US: a family's perspective

          Originally posted by Rajiv View Post
          Jay,

          A hypothetical question -

          As a medical professional, what would you do, if there was a inexpensive simple treatment that prevented the symptomatic ravages of old age, however if widely adopted, would reduce your real income substantially?

          I know about the "hippocratic oath" which sometimes in real life becomes the "hypocritical" oath.
          Rajiv, your hypothetical already exists. It is called preventative medicine and living a healthy life. You can easily increase your chances at a long healthy productive life if you follow the obvious rules. Healing is what being a caring physician is all about and nipping disease in the bud is the most refined medicine there is. On my death bed I'm not going to care about a few shiny coins, but I will know that many of my patients quit smoking because I take the extra time when I see a smoker to tell them it is a really bad idea. I don't pull punches. I have made a bigger difference in my career as an Emergency Doc getting people to quit than I have saving people from death's door. And I mean that.

          Comment


          • #6
            Re: Health Care in US: a family's perspective

            Originally posted by Raz View Post
            "I know about the "Hippocratic Oath" which sometimes in real life becomes the "hypocritical" oath."

            Yes indeed; and it's NOT all about money and maximizing procedures and profits.

            Original Oath of Hippocrates, translated into English

            I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and my judgment, the following Oath and agreement:

            To consider dear to me, as my parents, him who taught me this art; to live in common with him and, if necessary, to share my goods with him; To look upon his children as my own brothers, to teach them this art.

            I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.

            I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I will not give a woman a pessary to cause an abortion.

            But I will preserve the purity of my life and my arts.

            I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.

            In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.
            All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.

            If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot."


            From my perspective, when you are in medicine long enough, as a humane and aware individual, you start to realize that there is a time to die. Some may disagree but I don't think they understand suffering. If a suffering patient with no hope for a turnaround, who has the capacity to understand the decision they make, wants to die, so be it. It is the physician's place, as someone who understands disease, to help a patient make educated choices that suit them. That would include living wills. Jack Kevorkian is a brave and enlightened man.

            Comment


            • #7
              Re: Health Care in US: a family's perspective

              I think that how medicine lives up to its oath and ethos is deeply disappointing in many respects. But there's still remnants there and the doctors that sincerely have it in their hearts to provide the best health service rather than the most highly paid keep some honour in the profession. The Cuban medical system - not having much money to go round - focuses on prevention and does a great job. They even managed to train 1000 East Timorese doctors post independence, Australia trained 2; which is a good thing as the Cuban training must be far better matched to the timor resources than the Aussie trained ones.

              Comment


              • #8
                Re: Health Care in US: a family's perspective

                thx for posting. excellent discussion.

                Comment


                • #9
                  Re: Health Care in US: a family's perspective

                  Great article Jay, thanks for sharing.

                  Comment


                  • #10
                    Re: Health Care in US: a family's perspective

                    You may shocked to learn that for many doctors staying in the middle class, what is left of it, is difficult. I know of family practice docs and surgeons who make less than 100k/year. Medical school leaves most of us with at least 100k of debt and that doesn't include college. Do the math. The financial pressures that fall on the rest of society also pervert physicians, despite the best intentions of most of those who enter. I can tell you, for sure, that the preponderance of the people I know from school went out into the world wanting to do the right thing. Not all, but most. What you see is a symptom of our financial system.

                    Comment


                    • #11
                      Re: Health Care in US: a family's perspective

                      This is painful to watch.

                      Traditional medicine, like traditional schools, families, neighborhoods, banks, and so many other local institutions are destroyed, one at a time, by giant ethically challenged corporations seeking greater short term profits.

                      Then when the traditional alternatives, such as the Dr. Fales in this article, are successfully shunted aside, the faux care or service or product that the corporate giant had been providing instead is daemonized, to justify "wasting" fewer corptocracy profits on it. We end up in some debate over whether medical counseling of gravely ill elders is the work of "death panels" or the wishes of seniors who do not wish to suffer too much in their last years.

                      Meanwhile the chronic illnesses of cardiovascular diseases and cancers run epidemic in our "modern society", caused by industrialized agriculture and food processing, lining the pockets of major medical and pharmaceutical firms.

                      Get them really, really sick, for a long time, and then engage in a national debate as to whether expensive medical procedures that drain the nations pocket book with little benefit, even harm, to the sick patients quality of life are "good" or 'bad".

                      This debate is really sick and deeply inhumane.

                      Sure, modern medicine is quite successful addressing the problems of earlier generations, such as death in childbirth or early childhood, death by trauma and death by infection.

                      But they (*) are doing a terrible job with chronic illness. They are generating great profits, but not providing economical and humane care in the bests interests of the individuals well being.

                      (*) "They" being some of the giant amoral corporations and some of the doctors and executives who have succumbed to the profit seeking motive over the care giving motive.
                      Last edited by ThePythonicCow; June 21, 2010, 09:43 PM.
                      Most folks are good; a few aren't.

                      Comment


                      • #12
                        Re: Health Care in US: a family's perspective

                        Yeah totally agree. One of my old man's hats was as an accountant and he knew of family practice docs earning less than 40k a year here. Substantially less than average wage here. Market failure. But I also know of many docs who are deeply disappointed with the profession, you get that everywhere I guess, many of the rich ones - surgeons owning operating theatres charging huge rent, operating fees and any other charges possible - seem to think its great.

                        Comment


                        • #13
                          Re: Health Care in US: a family's perspective

                          Originally posted by ThePythonicCow View Post
                          Meanwhile the chronic illnesses of cardiovascular diseases and cancers run epidemic in our "modern society", caused by industrialized agriculture and food processing, lining the pockets of major medical and pharmaceutical firms.
                          I agree.

                          Get them really, really sick, for a long time, and then engage in a national debate as to whether expensive medical procedures that drain the nations pocket book with little benefit, even harm, to the sick patients quality of life are "good" or 'bad".
                          So we are clear, "get them sick" is not in anyway a belief of any physician that I have ever met. It presupposes intent which would be criminal, never mind anathema to the core belief of being a physician. At a high corporate level, there may be a few physicians who think this way, as it takes a psychotic mind to reach some of these positions. I would give you more leeway if you want to include subtle unconscious practices that alter management.

                          This debate is really sick and deeply inhumane.
                          Which debate, can you be more clear?

                          Sure, modern medicine is quite successful addressing the problems of earlier generations, such as death in childbirth or early childhood, death by trauma and death by infection.
                          I agree and there are many other illnesses too.
                          But they (*) are doing a terrible job with chronic illness. They are generating great profits, but not providing economical and humane care in the bests interests of the individuals well being.
                          I would also agree but it is a multifactorial problem. I don't know of any physician who recommends eating at fast food joints, lounging on the couch watching TV and smoking all day.

                          Comment


                          • #14
                            Re: Health Care in US: a family's perspective

                            Excellent stuff, thanks for posting. The whole thing reminds me of a book by an old professor of mine, Ivan Illich. He had developed a tumor on his face in the eighties and refused Western medical care, as he felt that the entire system was a threat to the health of the society. By the time I met him the tumor was larger than a softball, about cantaloupe sized.

                            Comment


                            • #15
                              Re: Health Care in US: a family's perspective

                              That looks a lot like the pyramid debt scheme that we live in, doesn't it...

                              Comment

                              Working...
                              X