overtreatment


Palliative Care – Not Just for the Dying

I used to think that palliative care was just for people who were dying. Then I found out—about a dozen years ago—that palliative care had expanded its original focus on end-stage cancer patients to include people with serious illness throughout the course of their disease (or diseases). Palliative care, I realized, is far more than […]

Re-Designing Medicare

Under the headline “Greedy Geezers,” the cover of the March 28, 1988 issue of the New Republic shows a phalanx of angry over 65ers surging forward, toting golf clubs and fishing rods. The accompanying article by Henry Fairlie, 64 at the time, excoriated over 65ers as being out for themselves and ready to bankrupt the […]

Overtreatment of elderly diabetics

The last time I was directly responsible for treating diabetes was fifty years ago, when I was an intern in medicine at UCLA. In my subsequent career as a psychiatrist I was not directly responsible for diabetes care, and as an individual, I don’t have the condition. As a result, I haven’t kept up on […]

The Medicare Social Club

Days from her 80th birthday, “Nancy” (not her real name) is doing well.  She’s active, exercises, drives, travels, and lives alone in a multi-story apartment building without an elevator.  Her busy schedule of weekly activities includes several appointments with physicians.  Nancy’s medical needs are covered by Medicare. Nancy’s been in psychotherapy for a half-century.  She’s […]

Avoiding Futile Care and Reducing Medicare Costs

If we in the U.S. ever hope to get a grip on Medicare costs, our society will first have to navigate a steep learning curve. That’s the lesson to take from three recent publications.  Despite the fact that Medicare is expected to represent 18% of the federal budget in 2020 (up from 15% in 2010), […]

No Sense, Lots of Dollars

Twenty-five years ago, discussions of medical futility were the rage in bioethics circles. The discussions petered out when it became clear that futility was in the eye of the beholder: physicians and patients often had very different ideas about what futility meant, depending on what they hoped medical treatment would accomplish.     In one […]

Why the Elderly Should Support Health Care Rationing

On the face of it, it would seem preposterous to argue that the over 65 population should support health care rationing. After all, both Democrats and Republicans regularly pledge to protect Medicare from any changes and attack the other party for threatening the program. And in a 2012 Pew Foundation poll, over 65ers by a […]

Treating Older People in the Emergency Department

In my 16 years in Emergency Medicine in England it has become increasingly common to see people over 85 years of age. This is an experience shared with ED colleagues from several other countries. Even the proud near-centurion awaiting a “letter from the Queen” is a not infrequent visitor to my department. EDs are increasingly […]

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 […]

Avoiding Unneeded Tests

In my previous post, I talked about medical tests and how “normal” and “abnormal” results do not always correlate to healthy or sick.  The bottom line from that discussion is that while tests are essential to diagnosing illness, they are fallible. Put another way, if you do enough testing on anyone, some tests are bound […]