The Way Americans Die

It’s getting worse:

The number of Americans experiencing pain in the last year of life actually increased by nearly 12 percent between 1998 and 2010, according to a study released Monday in the Annals of Internal Medicine. In addition, depression in the last year of life increased by more than 26 percent. That’s the case even though guidelines and quality measures for end-of-life care were developed, the number of palliative care programs rose and hospice use doubled between 2000 and 2009.

Jason Millman looks at why this is:

[Report author Joanne Lynn] sees two major possible explanations for her conclusion.

Patients and family members could be expecting more from the care provided and have “reset their thresholds” over the 12 years in this study. Another is that the number of treatments have increased, allowing patients to live longer with the diseases that ultimately kill them. “Maybe we’ve made more medical stuff coming at people that maybe let’s them live a little bit longer, but under much more burdensome circumstances,” said Lynn, who heads the Altarum Institute’s Center for Elder Care and Advanced Illness.

 interview, Volandes spells out his complaints:

I want patients to understand what “doing everything” means. I’ve since heard from other doctors who’ve done the same thing. People just don’t know what it’s like in there. As doctors, we sometimes say to one another, “Would anyone want this? We are torturing these patients.” But patients don’t know. I wrote the book because… I want people to be outraged. I want people to understand what’s happening behind those hospital doors. This is not a patient-centered healthcare system.

Update from a reader, with a classic bit of Dish TMI:

I should be dead. I had an infection in 2002 that would have killed me before World War II. I’ve had a few since then. The major problem in modern life is picking which antibiotic to use. We have a lot. The last round was given to me because whatever I had wasn’t responding to the stuff they usually give me when my cum turns yellow. That’s the symptom I have for it. Most men are in pain. I never am. They gave me something that has been around since before WW II and it seems to be working. Well it’s got something else added that makes it work better, but it’s in the same class of the pre-WWII wonder drug “sulfa”.

I should be dead because I had a heart attack that DIDN’T kill me in 1999. They made a small incision in my femoral artery, opened up the clog with a “balloon” and kept it open with stents. In 1989 they would have cracked open my chest and did bypass surgery. In 1979 they would have transported me to the regional hospital specializing in complex heart surgery and given me a bypass. In 1969 they would have told me I was very lucky to have this chance to make sure my affairs were in order. In 1959 the ambulance wouldn’t have made it there in time.

I’m going to be around to die a slow painful death from cancer in 2043. Or blow a brain artery in 2038. Which won’t be particularly painful, but not the way I would have died if they had never roto routed my heart.

Colon cancer “runs” in my family. Grandma died of pneumonia because when she got just a little slower because of the cancer the only antibiotic was “sulfa” and it didn’t work on whatever it was that was giving her pneumonia. It’s only been in the past few decades that me and the relatives have had to tell the doctors that we as the holder of the durable power of attorney have decided not to treat except for painkillers.

We live long enough for this to be a problem. And in there there may be a bit of a problem with end of life doctors being very cautious with the pain killers. More cautious than they were years ago.