Recently my brother sent an excellent article called “Medicine has become a service industry, and it’s making doctors unable to confront death” by Seamus Mahoney in Pulse on Linked-In.
Mahoney is the author of The View from Medicine’s Front Line: The Way We Die Now. In it, and in this article, he argues that doctors are more interested in pleasing and pampering the patient than in being honest. Few patients, and even less their families, are ready to confront the “Difficult Conversation” that death is imminent.
He maintains that ‘customer-friendly’ doctors are more interested in prescribing yet another test or another medication. He argues that they “over-diagnose, over-investigate and over-treat.” They continue to offer more medicines when there is no hope left. There is little interest and little to gain in having “The Difficult Conversation.”
My 98-year-old mother has certainly had the “Conversation.” She had a sister with untreatable lung problems who didn’t need the “conversation.” She simply quit eating, drinking only water over a six-week period. She passed away quietly with no great efforts at medication or resuscitation.
When we discussed this with Mom, she shrugged it off. She just thinks its morbid and wants no part of it. However, she knows that she has come to the Residential Facility to die. As she said, she is doing a very poor job of it. She has certainly not quit eating.
Last week Mom insisted on a visit to a “real” doctor. The wound on the back of her ankle had spread and her leg was red and inflamed. My poor efforts at treating her wound with aloe vera and Neosporin had failed miserably. I took Mom to the @CHIStLukesER which is right up the street from our Residential Facility.
At the ER, a very kindly, ‘patient-centered’ doctor studied her wound and pronounced it infected. He prescribed an antibiotic and an X-Ray to make sure the bone had not been infected as well. His nurse then bandaged it practically from knee to ankle with a pad nearly 2 inches thick. He suggested that I wash and rebandage the wound three times a day. I blanched. I may have worked as a Nurse’s Assistant forty years ago, but it was not a task I looked forward to.
I scuttled back to the Facility and asked about having the nurse from the Assisted Living Area come and do the bandaging. A very large, heavy-set woman arrived, pointing out with great self-importance, that she was a nurse. (She was an LVN, not a Registered Nurse). She cut open the bandage and studied the wound and agreed that she might be able to fit in redoing the wound twice a day since she was already on the grounds.
When I asked how much, she hesitated. After some hemming and hawing, she said she would have to consult with her director. It appears that most people at this Facility are wealthy enough, and endowed with enough insurance, to be able to pay for wound care without a second thought. Not me. She disappeared, leaving Mom’s fancy bandage lying open. She didn’t return.
Not sure what to do, I went back to the Assisted Living area and found one of the young Home Health Care physical therapists. Medicare did pay for wound care, he said, but it had to be prescribed by a doctor. He gave me his card and urged me to call his company, STAT Home Health Care. It turns out his company was different than the other nurse. Who knew that these companies are in competition for patients?
I jumped in the car and drove over to Mom’s regular doctor across the highway to ask for the orders for Wound care. Nothing doing. They couldn’t prescribe anything until they saw her. I drove back to the Facility, picked Mom up and brought her over. There followed the nicest possible interlude, leaving Mom pleased and happy, and overjoyed with the medical profession.
The sweet young nurse treated her like she was family. The even younger and newer doctor, fresh out of medical school, I’m certain, was kindness itself. His bedside manner was the height of cheerful courtesy. He prescribed blood tests and was happy to call the Home Health Care people. He insisted on seeing us again next week to check on the wound. Then his sweet young thing bandaged Mom’s leg again. I took Mom home while she beamed and proclaimed the benefits of “real” doctors.
The next morning, I redid Mom’s bandage, carefully washing and bandaging the wound with a kit from the Drug Store. Fortunately for me, and for Mom, the Home Health Care nurse came the next day and has continued to come ever since. Blessings on their little pea-picking souls. No need for any more bandaging by me or any more ‘Difficult Conversations.’