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Monday, December 25, 2006

Are All Doctors Like This Now? Is it Now the Hypocritical Oath?

Maybe it's the American medical system or maybe it's the lack of bed-side manners being taught in medical school now, but given how the doctors are treating my grand-mother, I'm extremely dissapointed with the care they're giving her. The hospital she's staying in is one of the top hospitals in the entire country, and they can't give the courtesy that a 97 year-old woman deserves. Truth be told, that's bumming me out and depressing me more than my grand-mother's condition. The way I see it is this:
She could have allowed herself to go last Thursday, but she decided not to. She decided that she has something to stick around for. So, she's taking care of her part. It's up to the doctors to do the rest, and they don't seem to be giving it their best effort.

It started out bad, and it hasn't gotten any better since then. When she went into the ICU and put on a breathing tube, the doctors couldn't comprehend how or WHY my father and Uncle wanted to keep her alive. They kept using the same quality of life b.s. over and over again.
"What measures do you want us to take?"
"Would your mother really want us to keep her alive like this?"
I think they asked my father and uncle the "Would she really want this?" question about a dozen times before they finally told the doctors:
"You don't know our mother. She may be 97 years old, but when she doesn't have tubes every-where, she's a very lovely, beautiful, and vibrant person. She's our mother, and we want you to do everything possible to keep her alive."
They seemed to not comprehend this, either and asked again:
"But, what kind of QUALITY OF LIFE would she have?"
They finally got so fed up and said:
"Listen, we're Jewish. Do everything to keep her alive, and that's that. We don't believe in your relative definitions of 'quality of life'." READ THE REST...

I don't understand this. Do all doctors think now-a-days is that once you're passed a certain age, you're no longer worth putting all the effort into in order to save?!? Do they think that just because my grand-mother's pushing 100 that she's not worth having the doctors giving every bit of effort, respect, and courtesy that she, as a HUMAN BEING, deserves?!? She's NOT her medical insurance! She's a beautiful and amazing human being that has had at least one family member with her 24/7 since she's been in the hospital. She's not just some medicared old person with no family that cares about her. At this point, the doctors should have figured out that she's cared about by her family.

The husband believes that the reason that she's being treated with such wanton disrespect is because of her insurance. She has medicare. She doesn't have private insurance. This means that they won't see a return for her care. Sounding crude and bottom-line corporate America yet?!? But, honestly, is this what the American medical system has turned into? She's 97, so she also won't be around long enough to "enjoy" all the glorious medical care and tests they should be doing. Case in point, the fluid in her lungs. There are about 4 doctors taking care of her case. One of them is a religious person that also happens to be a friend of the family.

Side story: This is how amazing my grand-mother is, and I don't care how much I tout her. This is not an ego trip, it's simple fact. My grand-mother has always made a positive impression of every person she comes across. After 5 minutes with her, you can't help but fall in love with her. One of the reasons her nick-name is Miss Hollywood is the type of personality she exudes. When Clinton was President, she used to joke that he was going to leave his wife to run off and have an affair with her. She also used to joke that he would sneak out of the White House, fly to Detroit, and crawl through her window on week-ends. Anyways, she was so charming, no doctor would ever charge her for care. Many times, her medicare wouldn't cover all the treatments from her doctors, and they wouldn't charge a dime. Doctors loved her. She's a bit of a flirt. They love it. They love to treat her.

Back to the story at hand. So, one of the doctors is a frum guy that promised my parents that he would look out for my grand-mother and make sure that the doctors did everything possible to take care of her and treat her. All the doctors knew that the fluid building up in her lungs was preventing her from being able to breathe on her own. However, 3 out of the 4 doctors disputed whether it was "WORTH IT" to drain the fluid. One or two of them argued that it would be a waste of time because they didn't know whether it was the pneumonia causing the fluid build up, or her congenitive heart failure. If it was her heart then draining the fluid would be pointless because it would mean that her heart was in its last leg. So, basically, to paraphrase, "What's the point of doing a multi thousands of dollars worth of procedure when the old bag's going to kick it any day now, anyways."
The other doctor said that they were afraid to do the procedure because of the risk of nicking her lungs while draining the fluid.
The religious doctor basically put them all in their place by telling the first couple of pricks that whatever the cause of the fluid, they would HAVE to drain the fluid to find out the cause of the build-up. Then, he told the other guy that there was no way that they would nick the lungs because all the tests and scans confirmed that there so much fluid build up that they never even reach the lungs.

Lo and behold, the religious doctor's advocacy and fight for my grand-mother worked. After much delay, they finally drained the fluid, and they NEVER touched the lungs, and the fluid was due to the pneumonia.

So, here are my questions. This religious doctor is an amazing man. He wasn't doing what he was doing simple because he knows my family and cares for my grand-mother. As a religious man, as a religious doctor, that came from a religious upbringing, he obviously has developed a strong respect and sanctity for life, all human life. My grand-mother may be 97 years old, but to him, she deserves as much of his care, attention, respect, and effort as any 20 year old patient. So, why are the other doctors acting the way they are? Is it because of her insurance or lack there-of? Has American medicine become so incorporated that the monetary bottom line has become more important than the care of the patient? Has it gotten to the point that because my grand-mother is 97 years old that even if she had private insurance, she would get treated poorly because her age means that their efforts would soon be wasted? Or, is it because of the increased secularization of America and the West? Has moral relativism and subjective definitions of "quality of life" trumped all sense of right and wrong, respect for fellow human beings, and morality of life? Does any-one understand what's going on here? Can you please explain it to me?

I want to make it clear. I think that the American medical system is probably the best in the world. But, there are serious flaws in the system, and it's gotten to the point where medical malpractice fees and law-suits, etc have gotten so bad that premiums and medical insurance costs have gotten to the point where even if you're making above the average salary, you probably can't afford decent health insurance. The system needs an over-haul, but if it's gotten to the point where doctors are being taught and/or forced to put cost/benefit analysis above proper care for the patient, than the medical system is in an even worse state of affairs than previously imagined. I'm sickened by this. I hope some-one has some answers for me.

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At 4:34 PM, Anonymous Anonymous said...

There is one easy explanation: the system is no better than the human beings that populate it.
In other words - doctors are human beings like the rest of us - some good, some bad, most confused, tired, and just trying to survive another day (although for what, only God knows - they sure don't).
Living in a secular society has something to do with, although don't forget that secularization was responsible in the first place for the
Western medicine that we all enjoy today.
Anyway - good luck and i hope you will be fortunate enough to enjoy your grandma for many more years.

At 10:35 PM, Blogger Olah Chadasha said...

Well, much to the doctors' chagrin, she IS doing better and is starting to be able to breathe on her own. Darn for them...

At 4:46 AM, Blogger Irina Tsukerman said...

First, I'm really glad she's continuing to do better. What an amazing woman!

Secondly, my thoughts on the doctors:

Personally, I've met some wonderful doctors who continued provide very humane care for my own grandmother right up to the moment she passed away, and who never EVER dared to pressure us into any kind of decision. I've also seen some horrible characters who deserve to have their licenses taken away. So it all depends on the person and the way they choose to exercise the power they are granted as doctors.

Secondly, the doctors have a duty to inform you of all the consequences of your decisions in your choice of care, but they have NO right to pressure you into anything. It is ABSOLUTELY the family's prerogative to exercise the choice in this situation. The hospital should have an Ethics Committe, and if this behavior persists you might want to discuss it with them.

Finally, the doctors have a LEGAL DUTY to provide the BEST CARE POSSIBLE. If you even SUSPECT that they are not doing what they are supposed to and are being negligent, you absolutely have the right to take issue with that. I suggest discussing it with the doctors themselves first, and if their behavior doesn't change, taking it up with their supervisers. Criminal negligence charges and malpractice measures are in order if the above measures have no effect on the doctor's exercise of care. However, the way to minimize the ridiculous overburdened legal/insurance related situation you described is by taking them as a last resort, if you see that the steps I mentioned did not work at all and the patient is not being cared for properly. The problem is, many people file lawsuits frivolously and in situations when it's unclear who's at fault. However, that's no reason not to do anything about unprofessional doctors.


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