Monday, February 16, 2009

A New Style of Hospital Admission Form

There are many reasons why our American health care system is so much more expensive than those in other developed countries, and yet we have inferior results. But, by far the largest single reason is the delivery of non-beneficial care which accounts for about one third of our total health care bill and contributes to a tremendous amount of unnecessary human suffering. Perhaps the most obvious example of our inappropriate care is the prolonged anguish and cost associated with the way we practice end-of-life care. Unfortunately however, the irrationality of how we practice medicine in the United States is not isolated to end of life care. Issues that must be addressed are:
•How can we create an advance directive that is both up to date and rational considering the over-all condition of the individual?
•How can we ensure that the care being given is beneficial and not serving other masters such as cash flow, avoiding legal hassles, the prestige of the hospital, etc.?
•How can we make sure that every patient and family has the right to appeal the medical team’s decision as to what is beneficial?
•How are we to avoid doing cardiopulmonary resuscitation on patients that are far too frail to benefit and who as a result suffer a disfiguring inhumane death?

The answer to these questions is my proposed hospital admission form shown below. The form provides a realistic up-to-the-moment advanced directive while providing an opportunity for the patient/family and the medical team to agree on what will be beneficial care. It also provides the patient/family and the medical team a mechanism to resolve disagreements, the appropriate care committee. This new admission form would also make cardiopulmonary resuscitation an ordered event for those patients who could benefit from it in any way, and not done routinely for the majority of patients for which it is of no value.

9 comments:

DrJoe said...

Great idea. Some care managers are using similar forms when patients are admitted to SNF's to decrease unnecessary trips to hospital for admissions.

Doctor Kenneth Fisher said...

Dr. Joe,
Thank you for looking at my blog and agreeing with the concept of an admitting form. I believe we could accomplish four points with this form; 1) an up to date advanced directive,2) the agreement that only beneficial care can be administered, 3) the creation of an appeal mechanism - the appropriate care committee, and 4) making cardio-pulmonary resuscitation an ordered event, thus reducing the number of obviously callous resuscitations. Kenneth A. Fisher, M.D.

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