end of life care


Return of the Hero

Blanched by anemia, Mary rested quietly in the hospital bed. Her pallor made her barely visible amid the bleached bed linens–she seemed a mere  shock of white hair against the pillowcase. Age 93, she’d visited the hospital a half-dozen times in as many months, shuttling between nursing home and hospital as many elders unwittingly do […]

Two Common Sources of Overtreatment

Experts, most recently former CMS administrator Don Berwick, tell us that no less than 20% – 30% of medical care is “waste.” At the very least, “waste” is harmful to all those who pay for Medicare. But often it’s directly harmful to the patient as well. I recently saw a friend at a party. Since […]

Becoming the “It’s Not All About Me” Generation

Some months ago my colleague, dear friend, and mentor, Gordon Moore, showed me the draft of a proposal he had written for Medicare reform. Gordon and I have worked together and exchanged ideas regularly for more than 30 years, so it’s not surprising that we agree that we in the over 65 generation are key for […]

Living Will, Dying Well

I glanced at the chart. New patient, female, age 72. I have adopted the practice with new patients of quickly scanning the medication list before opening the door to greet them. In the old days patients hand wrote their medications on a paper intake form prior to the office visit. Now I click the “medications” […]

Doctors Die Differently

Many years ago, my late father received a recommendation for carotid artery surgery. He had no symptoms, but his physician was concerned about kinking and possible narrowing of the artery. I described the situation to a vascular surgeon colleague. He thought the recommendation was questionable. I encouraged my father to talk further with his physician about […]

“Mommy’s” Long Life with Alzheimer’s Disease

My dear 99 year old stepmother, Virginia, has just been discharged from the supplemental hospice care program within her Alzheimer’s care facility.  Why? Because she has survived for almost two years beyond the six month prognosis for survival required for inclusion. She has not died and is considered stabilized. Her advanced Alzheimer’s disease is now […]

Do Not Transfer

They finally signed a “Do Not Transfer” order. The patient’s family had been reasonable enough, but they lacked medical expertise, and no one at the nursing home ever mentioned that an acceptable option could be to let a 92-year-old man live out his days, unencumbered by transfers to the emergency room for every attack of […]

Learning from my Mother’s Hospice Care

My mother has been in hospice care for the past five months, after three months of almost daily visits with doctors and recurrent visits to the emergency room, and pointless hospital admissions fraught with tests designed to diagnose problems which would require surgeries that she could never survive.

Trying to Practice What I Preached: Helping my Parents at the End of Their Lives

Once again, the challenge of how to constrain rising health care expenditures has caught the public interest, stimulated by concerns over rising federal debt and limited ability to generate tax revenues. I recently chronicled my unsuccessful efforts at stimulating medical cost containment from both academic and foundation positions (1971–2002) in the April 23, 2011 issue […]

A Lesson in How to Die and How to Live

In the summer of 2005, my mother was 82 and had been in frail health for a while. Angina, hypertension, and chronic congestive heart failure were under control following an aortic valve replacement six years previously. Upon her return to Boston from a trip to New York for our daughter’s wedding, we noticed that her […]