Comment by Bill Baar

September 2, 2009 @ 12:26 pm

An “Order” is clinical jargon. We write “orders” for patients.

Comment by Jess

September 2, 2009 @ 12:45 pm

What’s your point? An order written for a patient is a list of actions for a doctor or a nurse to take for the patient’s treatment. This bill clearly defines an advanced directive “order” as coming from the patient, with advice from a physician (advice that the patient doesn’t have to follow if they don’t want to in crafting the order).

Comment by Bill Baar

September 2, 2009 @ 1:11 pm

My point is an “order” is clinician speak for a task. It’s not an order to the patient to do something.

HR3200 allows Docotors (the least qualified in my opinion to do this sort of consult) to bill Medicare for the “order” in addition to the regular office visit bill. The expectation is EOL couseling will save something on the order of $29.7 billion in 1994 dollars (Ezekiel J.Emanuel)

I don’t know how much savings CBO scored the EOL provision in HR3200 in today’s dollars.

Comment by Jess

September 2, 2009 @ 1:38 pm

How sad that you don’t have a doctor you trust to give you information on your options for end of life care. I think a doctor is the MOST qualified person to do this kind of consultation, because they are the ones who are trained in the realities of the medical treatments involved in either “heroic measures” or in letting nature take its course. And there’s no reason a patient couldn’t invite anyone else, from a chaplain or minister to family members to their yoga teacher, to take part in the conversation as well.

They’re getting paid for the consultation, which results in a document. If that consultation is the only thing that happens in the office visit, that’s all they get paid for.

And what’s wrong with saving money through end of life counseling? Your argument seems to be that doctors will pressure people into choosing to forego medical treatment, when there is no basis for this assumption. In fact, the way our current system works, doctors and hospitals make more money keeping patients alive through heroic measures than they do by obeying Do Not Resuscitate orders.

The more people are aware of their options, the better personal choices they can make, whether that is to request a DNR or to request being kept alive by any means necessary. Private insurance companies already pay for this kind of counseling from doctors — this bill would empower Medicare and the public plan to do the same.

(I removed your link because the article you tried to link to is not publicly available without a subscription to the New England Journal of Medicine.)

Comment by Bill Baar

September 2, 2009 @ 2:07 pm

I work for a Doctor. I work with Doctors. I work stones throw from a major Medical School. They’re poorly trained for this type of consult. I would go to a hospice for end-of-live care. Not my primary care Doctor.

I worked for a Doc you created one of the first Hospices in the US, which is why I believe most Docs are poor resources for this kind of care.

(next comment)

…which is why I believe most Docs are poor resources for this kind of care.

I mean most Primary Care docs are poor choices for palliative care.

(next comment)

…don’t have a doctor you trust…

My personal Doctor doesn’t do interventions he’s not trained to do. A big reason why I trust him. He doesn’t consult end-of-life or palliative care (and many other things) because he’s not trained to do.

Comment by Jess

September 2, 2009 @ 2:50 pm

Then go to a doctor who is trained for it, duh.

This provision of this bill is for VOLUNTARY counseling, so that a doctor can get paid for providing a service to a patient. If a doctor isn’t trained for doing this kind of counseling, a patient can always go somewhere else.

Also, H.R. 3200 provides funds for more doctors to GET trained to do counseling on end of life options. At this point, Bill, you’re arguing for the sake of argument, and not because you have a valid point.

(your comments consolidated for clarity)

Comment by DairyStateDad

September 3, 2009 @ 12:47 pm

My former spouse is a doctor who works in the long-term care field. While she would agree (I think) with Bill that many doctors currently are not well trained for end-of-life counseling, she strongly believes they should be, and that this sort of counseling should be provided for in any health care plan. Further, as to the point of whether doctors are qualified or not, if some other professional is more qualified, then provide for that person to offer the counseling. Make sure the complex health care system communicates the availability of that counseling, whoever provides it. And, again, cover it.