By Lee Landenberger
We just put the final touches on a new book here at AHC Media. The Horrors of the Hospital: Successfully Navigating the World of Medical Malpractice is out now. The book is designed to help healthcare professionals understand the legal system in regards to hospital malpractice claims and cases. It details actual court cases with a summary and the authors’, who are lawyers, commentary on what the case means for the reader and how to avoid such problems in the future.
Technology continues to develop at a breakneck pace, much of it geared to giving more power to the patient. In Why Healthcare is (Finally) in for Big Changes, Reggie Bradford, Senior Vice President at Oracle and a former high-level exec at WebMD, pens a first-person view for Forbes of the essential changes he seems coming, especially concerning electronic health records.
Those changes, he predicts, will not only empower patients but drive healthcare costs down.
“The market needs innovation, and emerging standards initiatives like Fast Healthcare Interoperability Resources and healthdata.gov are signs that point to a brighter future,” he writes. “As important moving forward is the need for platform technologies that not only leverage patient and clinical data, but operational and genomic data as well, for better decisions, better health, and lower costs.”
One of his driving principles at WebMD was to put more power in the hands of patients. That remains his vision for EHRs.
“Despite all the technological advances in smartphones, my medical records are still controlled, by and large, by my doctor,” he writes. “For instance, if I need to visit an emergency room on a business trip, there’s no easy way to access my medical records electronically. The industry and patients agree that this has to change, and we have the technological innovation at hand to clear this hurdle.”
The New York Times Editorial Board came out this past week for stronger aid-in-dying legislation in state houses across the country. In Offering a Choice to the Terminally Ill, The Board points to the failures in helping those who die unnecessarily in agony and sees hope with laws like those in Oregon.
“As local lawmakers around the country debate the bills, they should consider how successfully and responsibly the law has been carried out in Oregon,” the Board wrote. “The state’s Death With Dignity Act, which went into effect in 1997, gives doctors the right to prescribe a lethal dose of medication to patients who are terminally ill and who have been advised of their alternatives, such as hospice care. The law provides layers of safeguards to ensure proper diagnosis of the disease, determine a patient’s competency to make the decision, and protect against coercion. Last year, 105 patients in Oregon, a record high, died after receiving a lethal dose of medication.”
A dying patient sparked a doctor’s essay in The Washington Post, in which he found that asking the right questions of patients gave a good measure of peace of mind to him and those he treats. Instead of fulfilling impossible requests, he finds it’s all about goals.
“I would like to be able to walk without falling,” he says. “Falling is horrible.”
This catches me off guard.
But it makes perfect sense. With challenging medical conditions commanding his caregivers’ attention, something as simple as walking is easily overlooked.
A wonderful geriatric nurse practitioner’s words come to mind: “Our goal for younger people is to help them live long and healthy lives; our goal for older patients should be to maximize their function.”
Suddenly I feel that I may be able to help, after all.
For those physicians cannot help any longer, officially declaring a patient no longer among the living has gotten a little tougher with technology. And with that wrinkle also come ethical problems, as pointed out in Medical Technology Makes ‘Time of Death’ Harder to Pinpoint in The Atlantic.
“It can seem logical to equate life with the detection of brain activity by a PET scan; the miraculous saves possible with ECMO, too, might lead physicians to equate the circulation of oxygenated blood in and out of the body with living. But both equations are too simple, reducing complex issues about the end of life down to scientific definitions that lack nuance,” writes Tim Lahey, an infectious diseases specialist and associate professor of medicine at Dartmouth's Geisel School of Medicine. “PET scans and ECMO are great technologies, but they cannot answer a question that is primarily about a patient’s values and preferences. The line between life and death is best defined not by machines, but by patients’ beliefs about what kind of life gives them meaning, and how much they would endure to extend it. If PET scans and ECMO fit into a patient’s wishes, then it makes sense to marshal the full power of these technologies, even with the understanding that they may fail. On the other hand, if these machines cannot restore for a patient the kind of life he wants, then the way to use these technologies may be to … hit the off button, or better yet, don’t turn them on at all.”
Lee Landenberger is AHC Media’s Continuing Education and Editorial Director.