“TRICK or TREAT”


As Halloween looms, I’m reflecting, metaphorically, on what occurs in healthcare everyday, particulary as it relates to the management of patients with advanced illness. With over 50% of our healthcare expenditures occuring in the last few months of patients’s lives, one must wonder about the care-effectiveness and cost-effectiveness of much of the pedantic active/aggressive medical micromanagement (AAMM) that is rendered in this clinical context. One must also wonder if it is being delivered as a result of truly “patient-centered” care or simply expediently driven by a “doctor-centered” approach. Let’s face it, it is much easier to micromanage irrevelant minutia instead of having a fulsome and often exhausting discussion with patients and families that includes details around natural history of disease, prognosis, and evidence base. Research has demonstrated that when appropriate counseling is delivered, patients with advanced illness tend to choose conservative palliative management (CPM) over burdensome, expensive, and futile late-stage AAMM. Therefore, when the latter is administered to patients, are they being “Treated” or “Tricked” ?

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About drvincentmaida

Consultant in Palliative Medicine & Wound Management, Assistant Professor, University of Toronto & McMaster University, Researcher & Author.
This entry was posted in Bioethics, Distributive Justice, Palliative Medicine, Promoting PCC & PE. Bookmark the permalink.

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