Is There Such Thing as “Too Much” Care?

Among the many dilemmas faced by physicians in today’s healthcare system, one of the trickiest is deciding how much care is enough – and how much is too much.  Armed with ever evolving technology and treatment options, and without clear guidelines on both an ethical and evidential basis that declare when “enough” care has been given to a patient facing a chronic or terminal diagnosis, doctors frequently continue to treat and monitor when their efforts no longer contribute to improving the quality of life for the patient.

This comes to mind upon considering two recent articles posted by Health Leader’s Media.  The first article reviews the increasing rate of imaging studies completed on Stage IV cancer patients.  Despite a lack of outcomes data to show that additional imaging studies are valuable or appropriate for Stage IV patients beyond the diagnostic phase of treatment, these patients continue to receive scans on a regular basis.  While there is some evidence that this data can lead to treatment gains or the development of appropriate palliative care, overall the evidence does not support the high cost of these arguably unnecessary additional imaging studies.

The second article that points to the issue of defining the “appropriate” level of treatment focuses on the increase in palliative care programs in hospitals.  Palliative care seeks to make patients with chronic conditions more comfortable without seeking a cure for their condition. The difference between palliative care and hospice is that while hospice specifically addresses end-of-life care, palliative care can be ongoing for patients who do not have a terminal condition.

The expansion of palliative care programs is notable in that the decision to transition a patient to palliative care requires his doctors to decide that “enough” curative effort has been applied to a chronic or terminal condition, an acceptance that the patient is not going to improve, and acknowledgement that the appropriate focus is on managing pain and other symptoms. This decision flies in the face of the general American make-it-better-at-all-costs mentality that controls most healthcare protocols.

The focus of the article is specifically the expansion of palliative care within the hospital setting, but this shift in treatment focus is also highly relevant to the long-term care industry. If palliative care gains more momentum, and is acknowledged as a valid treatment protocol outside of the short-term context of hospice, the potential for long-term care facilities and home care agencies is huge.

As the possibilities to diagnose, treat, and monitor health conditions grow and expand, we face a dangerous slope. There is no question we have to rein in costs, and introduce accountability and management to healthcare if we are to succeed as a nation.  However, we have to be vigilant that we don’t succumb to baser proclivities and allocate life-saving, expensive therapies to those we, as a youth-oriented culture, subjectively deem fit and worthy of our healthcare dollar.  The line between prudent management and withholding care is just as murky as the one that defines “enough” – and neither should be crossed if we are to acknowledge healthcare as a basic right and not something that belongs only to the highest bidder.

10. August 2012 by David Weiss
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