The end marks the beginning: how hospice helps me think about health policy

Why blog about health policy? Well, by way of explanation, let me tell you about my morning…

Before heading into the office, I visited a patient at home. I know that sounds old-fashioned and maybe even unsafe these days depending on the neighborhood. However, weakened by metastatic cancer, my patient would not reasonably have made it to see me in my office before his demise. I therefore decided that our best option was a home visit. We spent the first part of our visit discussing his physical health (controlling pain, managing shortness of breath and addressing nutritional issues) then transitioned later to his emotional and spiritual health (acknowledging fear and anger and achieving peace). He grasped that the cancer was inevitably going to overcome him physically and yet, he continued to fight for every last moment to be with his family, several of whom had traveled large distances to be with him. After talking some time thereafter with his children and wife and answering questions, I left for my office.

For the uninitiated, hospice is medical care that is provided at the end of life. I am not referring to chest compressions, being put on a respirator, or epinephrine (stat!); I am referring to making an informed decision to be comfortable and amongst loved ones at home when the moment of death comes. For some, hospice may seem antithetical to our modern-day technology-driven success-at-all-cost sentiments. These very sentiments are partly to blame for the crisis in healthcare spending (projected to surpass 20% of our GDP in the next quarter century!) that our nation faces today. The bottom line = we spend too much on dramatic end-of-life care that is high cost-low impact. Why not spend your dying moments at home with your family and friends in peace? Why suffer an unnecessarily “violent” death in the hospital? It seems clear, doesn’t it?

Somewhere between “duh” and “no duh” lies our ability to approach healthcare reform in a rationale way. Things seem so obviously fractured yet we, as the general public, continue to accept things as they are. To borrow quotes from a friend and a mentor, silence = consent and if we’re not at the table, then we’re on the menu. Now is the time to use our voices together and to sit at the table. Look forward to continuing this dialogue with you and “imagineering” real solutions that serve everyone’s needs, not just those who are (financially) benefiting from the way healthcare in the U.S. is delivered.

Cheers, Jaywon