I never quite knew what to make of Jack Kevorkian, M.D., the recently deceased pathologist who became famous—as in serving prison time—for helping terminally ill patients take their own lives. Was he a grandstander? Or just ghoulish? Did he sincerely believe he was upholding the physician credo? He certainly thrust himself into the public spotlight, and although he has not been in the news lately, for a period of time in the 1990s he was, ironically, probably one of the most well-known physicians in the country. I never interviewed the man, and I always wondered how his career path took him down the road of assisting suicides.
Other physicians found him to be, shall we say, unsavory. After all, this is a profession dedicated to saving life, not ending it. The American Medical Association "strongly opposes any bill to legalize physician-assisted suicide" because the practice is "fundamentally inconsistent with the physician's role as healer.”
I’ve worked with enough physicians to know they are complex personalities. Their clinical skills can be extraordinary, and at the same time, their world views can be extraordinarily off the mainline. I heard one physician practice management expert explain that physicians are a group of people who sacrificed a good chunk of their youth in utter devotion to the task of getting through medical school and residency—a time when the rest of us were socializing. No telling how Dr. Death spent his youth.
The issue of end-of-life care continues to perplex us, however. And as I recently reported, Medicare spends a disproportionate amount of its budget on end of life treatment. It’s a huge financial drain. To me, the issue underscores the need for patients and physicians to discuss in an honest way their treatment options, such as hospice or palliative care. Many patients have created advance directives that spell out their wishes. And I have spoken with several hospitals that put access to the patient directives in clear sight on their inpatient documentation screens. In this way, the EHR can help remind the ever-shifting cast of clinical personnel who invariably participate in end-of-life treatment about what the priorities should be.
Ardis Dee Hoven, M.D., chair of the AMA Board of Trustees, wrote about the topic, chastising the government for abandoning a health reform law regulation at the beginning of the year that suggested physicians offer annual voluntary discussions with patients about end-of-life care. “The AMA strongly supports end-of-life planning and the use of directives to do just that -- give physicians and families directions as to the patient's wishes at a time when that otherwise might not be possible,” she wrote. “It's a difficult subject, dealing with a difficult time of life, but it's one that neither the medical community nor our society should walk away from.”
Now why can’t physicians like Dr. Hoven be on the front page?
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