There was a great piece in MPR this morning about managing chronic illnesses in the elderly and how and when to have end of life conversations. It was titled “When ‘overmedicalization’ goes too far”. There was discussion of the Gawande article that we highlighted last week and the speakers were
- Katy Butler: Author of a recent New York Times article, “What Broke My Father’s Heart.”
- Dennis McCullough, M.D.: Community Geriatric Consultant Associate and Professor of Community and Family Medicine, Dartmouth Medical School, who wrote “My Mother, Your Mother: Embracing “Slow Medicine,” the Compassionate Approach to Caring for Your Aging Loved One”
There was a lot of discussion about how doctors are rewarded for ordering expensive tests, but are not rewarded for trust building and having important conversations. I stayed in my car an extra few minutes to hear the section, quoted below, when Dr. McCullough made the point that we treat chronic conditions like a series of acute episodes rather thank a long-term event that takes planning and commitment.
“I think the basic design… and I am not alone in thinking of this… in the American medical system is to create quite wonderful high tech acute medical care and to ignore other important parts of the medical system… what we’ve failed to do… is not only ignore prevention, but we’ve ignored the engagement with people who have chronic problems so the problems that they have do not because crises repeatedly….. We are oriented towards managing crises and thrive on that, but don’t reward and thrive on prevention of these crises in chronic conditions.”
