Kentucky Doc Winter 2016 | Page 15

doc

Winter 2016 • Kentucky

rewards doctors for doing things, not for not
doing things. For now, doctors get a lot
more money for doing tests and procedures than they do for sitting down and
having difficult, unpredictable conversations
with patients and their loved ones. There is
hope on this particular horizon, however.
With passage of the “Doc Fix” this summer,
changes in reimbursement based on patient
outcomes, rather than payment for procedures, will be slowly phased in.
Finally, although time and money are very
important factors in the disconnect between
how doctors would prefer to be treated and
how they treat patients at the end of life, I
think a third and perhaps more important
factor is lack of leadership, on several levels.
At the first level is lack of leadership with
regard to care of an individual patient by
an individual physician. The physician is
(still) the leader of the team, and everybody
else takes cues from him or her. When the
physician ignores the plight of the moribund
patient and presses ahead with inappropriate
interventions, the entire team is compelled
to follow. When the hospital administration
tiptoes around the fact that many ICU beds
are filled with patients who cannot hope to
benefit from terminal care there, the whole

hospital system follows suit. When third
party payers continue to reimburse more for
futile, aggressive procedures at the end of
life than for palliative care, the dysfunction
is perpetuated. And when our government
is compelled to retreat from an attempt to
address this issue at the macro level, everybody loses.
What can be done? At the patient level,
people and their families need to become
informed and empowered. Relying totally
on the health care provider for information
and decision-making about any aspect of
care, including that at the end of life, is in no
one’s best interest. At the payer level, reimbursement based on meaningful outcomes,
rather than on volume and cost of procedures, will go a long way (and it is likely
that we are moving in that direction). But
perhaps most importantly, doctors need to
remember the Golden Rule.
Sources
1. Periyakoil VS, Neri E, Fong A, Kraemer H.
Do Unto Others: Doctors’ Personal End-of-Life
Resuscitation Preferences and Their Attitudes
toward Advance Directives. PLOS . DOI:
10.1371/journal.pone.0098246

15

Anyone who has
worked in an ICU is
intensely aware that
many patients who
clearly have no chance
for meaningful survival
are subjected to painful
procedures, incredible
expense, environmental
chaos, and separation
from the people and
things they love as they
are dying. Why is this?

Now and then, we don’t get
all the time we wanted

With Hospice you can make the most of the time left

[phone]
[phone]
www.hospicebg.org

The day we enter your lives, the
Hospice team treats you with the
respect, kindness, and dignity
typically reserved for one’s own
family.
• Providing medical care and
symptom management in the
home, nursing facility, assisted
living facility and Hospice Care
Center
• Joint Commission accredited
• Medicare/Medicaid certified
• Counseling and bereavement
services provided to the
community, as well as to Hospice
families
• Dedicated hospice unit
Hospice makes this
unfamiliar journey one
filled with comfort, dignity,
and compassion
© stock.xchng

Kentucky’s Leading
Hair Replacement
Facility

• Genetic Hair Loss
• Chemotherapy
• Alopecia
• Cosmetic Hair Replacement

859.263.9811
Hair Institute offers several surgical and non-surgical hair
restoration options, including Virtual Reality®, full and partial
prostheses, hand-knotted wigs, and human hair extensions.
- Laser Light Hair Therapy
- Surgical Hair Restoration Options

- Full Cranial Vacuum Prostheses
- Enhancements and Integrations

1795 Alysheba Way Suite 7101
Lexington, Kentucky 40509

HAIR REPLACEMENT • HAIR RESTORATION • HAIR EXTENSIONS
Professional • Confidential • Meticulous
AMERICAN
HAIR LOSS
COUNCIL

www.hairinstitutelexington.com

®