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Doctors need to speak out in support of end-of-life counseling

By Dr. Nikhil Wagle
. 1 Comment(s)

Thanks to Dr. Nikhil Wagle, oncologist at Dana-Farber Cancer Institute in Boston and member of the Doctors for America board for this guest post.


As an oncologist, one of the most important things I do for my patients is talk to them about end of life issues. I have these conversations with my patients regularly.  So it infuriates me when I hear all of these comments at Town Halls and in the media about "death panels" and "pulling the plug on Grandma."  They are an insult to doctors and patients everywhere.

Last week, I spoke with a patient of mine who is dying. I've known this patient for a long time. And in spite of many treatments we've tried for his cancer, nothing has been working. So last week, we spoke about his illness, and he told me what he wanted. He told me that he's tired of coming to the emergency room, and he's tired of being admitted to the hospital. He told me that he wanted to be home for the remainder of his life. He told me that he didn't want to suffer. And he told me that he wanted to die peacefully, in his sleep. We spoke about this at length, and he asked me to enroll him in a hospice program.

People have a right to talk about their wishes at the end of life. This includes setting up health care proxies and advanced directives, exploring their wishes about resuscitation efforts, and discussing end-of-life care options such as hospice. It is the responsibility of doctors -- whether they are oncologists or surgeons or cardiologists or primary care physicians -- to have these discussions with patients and their families. Such discussions ensure that an individual's wishes are respected at the end of life.  They also strengthen the doctor-patient bond.  Any physician will tell you that patients and their families benefit from these discussion.  In addition to the collective experience of physicians, medical research published in well respected medical journals also show that patients benefit from these discussions. And they benefit whether these discussions occur over 20 years through health and sickness, or over just a few days at the end of life.

We need to make it clear to everyone that the provision being discussed does one single thing: it allows physicians to be compensated for having these discussions. These discussions happen anyway -- compensated or not. But they need to happen more. And perhaps one of the reasons they don't happen enough is that there is frequently no way for physicians to be reimbursed for them.

Doctors need to speak out against these unconscionable lies. We know the importance of end-of-life counseling.   It is our responsibility to tell the public why this is so important -- not only for ourselves, but most of all for our patients.

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  1. rballal


    I agree with Dr. Wagle's comments. As an Internist/geriatrician with nearly 3 decades of practice, I am amazed at the ignorance of the general public with regards to the end of life issues. That we spend about 60,000 dollars during the last 6 months of our lives and nearly all of it is spent by government insurance is totally ignored by the right wing talking heads. In almost every nursing home in the country, there are at least half a dozen patients in vegetative or semi-vegetative state! Instead of providing them with compassionate, comfort care with hospice type programs, we treat them as cash cows, because, 1. our payment system favors us taking them to hospital and treating(torturing?) them and 2. family is given the understanding that prolonging death(and suffering) is better than a possibly shorter but, more comfortable life! Also, there are the late night TV Ads by trial lawyers asking whether any body had loved ones being treated at a nursing home, and they may be entitled for unlimited compensations for 'negligence'!

    Raghu Ballal

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