Geriatric doctor doesn't shy from tough talk

[bemildred]

Gene Dorio, an old-school practitioner in Santa Clarita, insists families — and physicians — have honest discussions about end-of-life issues with those in failing health. Too often the difficult conversations are put off for too long.

Previous post: http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=222x112083

Gene Dorio, an old-school doctor who makes house calls in Santa Clarita, drives a 1990 Volvo with 362,000 miles on the clock and duct tape holding things together. His patients have a lot of miles on them, too. Dorio is a geriatric physician.

"Medical technology allows us to live longer, but is it with the quality of life we want?" Dorio wrote after reading a column I wrote about my father's failing health. "The discussions are avoided and I believe physicians are responsible for this," Dorio went on. "For some, dementia sets in, but for those who remain cognizant of mind and body, life can dribble away. Who can say when enough is enough?"

It's not an easy question to answer, because as Dorio pointed out when I went to visit him, there's always something else doctors can do — surgery, meds, experimental treatment — to give terminally ill patients a little more time. But an estimated 25% of Medicare dollars are spent on those in the last year of life, with medical procedures often rising in cost as health deteriorates.

There's virtually no honest political discourse about this, though, and it's not just politicians who have failed. It's those of us who live in denial, unwilling to have uncomfortable conversations with loved ones, only to suddenly find that it's too late.

http://www.latimes.com/news/local/la-me-1127-lopez-dorio-20111127,0,3540007.column

[enough]

1. Having lived through Alzheimer's with my father and simultaneously with my mother's

vascular dementia, I am deeply concerned about this issue. There has got to be a way to actively end our own lives before we slide over into helplessness. I'm especially worried about dementia. It can come on you before you have the inspiration, or the courage, to commit suicide. Then, if you haven't done it, you leave your relatives to take care of you without any help or guidance from you. You have checked out.

We need a way to specify assisted suicide at a certain determined point. It has to be determined before it happens.

The toll on families' mental health, physical health, and financial stability is too great to let this go on the way it is.

[jwirr]

2. There are a lot of good doctors and other health care providers

who facilitate these discussions. I took care of my mother and my daughter who is still alive and made decisions for them. I also did this for my father before it was a regular practice. The help of a professional is vital to understand what is happening and what can and cannot be done.

[riverwalker]

3. love those old school docs

I worked with one whose geriatric patients adored him and his plain talking. Younger doctors would ask patients "do you want extraordinary measures, Full Code, do you have a Living Will, blah blah"? And the older patients wouldn't know what they are talking about.
Dr. Old School would say "Irma, you are 87 years old. If your heart stops, do you want us to pound your chest and put tubes in your throat? Because it probably won't work anyway at your age. Do you want that?" Once they knew what they were talking about, they would always say, "No I don't want that, when the time comes, let me go."
The problem is, we tippy-toe around the subject.

[Sarah Ibarruri]

4. This reminded me of something:

I'm a proponent of assisted suicide when someone wants it. BUT

He said these things:

"But an estimated 25% of Medicare dollars are spent on those in the last year of life, with medical procedures often rising in cost as health deteriorates."

and then said this:

"When I got word that my father had fallen and broken his hip after many years of heart failure and other major medical issues, part of me was ready to say that's it, let's let him go. But he's the type who would fight for every breath. What if the surgery, which he eventually underwent, keeps him breathing two more years in a state that he considers worth living, even if I wouldn't make the same choice for myself?"

A close member of my family is a doctor. Let's call him Dr. WhoCares. He is in his late 30s. He is physically fit, 30s is relatively young, and he is a GP. He is aware of the sad state of medicine in this country, and his views are not unlike Dr. Dorio's. He believes that excessive medical care goes into the elderly, and believes that needs to stop. He's strongly in favor of the elderly realizing their 'limitations' and being encouraged to refuse further medical care.

Needless to say, Dr. WhoCares' mother (of course also a member of my family) and I have decided we would rather be treated medically by a McDonald's burger fryer than by him, and have told him as much. Dr. WhoCare's own mother has given power of attorney to ME rather than him, should something happen to her.

What gives this Dr. Dorio (or Dr. WhoCares) the right to be convincing elderly people that they should want to exit this planet, simply because our health care is a mess? Who are *they* to push people into deciding to die? The frikkin' nerve these people just amazes me.

First, I'll betcha the money I have in the bank that Dr. Dorio and Dr. WhoCares, when they're older, will be first in line to be treated medically until their last breath. Usually people like this, are hypocrites par excellence.

Second, I understand that the elderly prove a tremendous challenge because they're weakened and their bodies are old, but if you're not cut out for the medical field and simply don't have patience or compassion for it, for chrissakes, don't go into it! Let someone with compassion go into it!

Third, if these doctors are so upset because the health system in this country is pure shit, why don't these doctors get involved in passing a single-payer system, so that our healthcare won't be the crap it is, instead of trying to send the elderly to the other side faster to save a buck?

Fourth, I despise the way people are fast-tracked into hospice. Fine, if someone is terminally ill, it's nice to have a place where nice girls smile a lot, provide pain killers, and prop up pillows, but far too many people are being fast-tracked into hospice.

Fifth, other countries take care of their elderly. Of course, other countries aren't car-nations, which are spread out and create a situation where no one can help anyone else. Why don't these doctors work on that, and push for better planned cities and towns, so that people aren't 15 miles from one another and wholly dependent upon the auto to even survive???

This issue just burns me up, really. Why are the elderly always thrown to the dogs???? I'm sick of it.

[virgogal]

5. I'm old and have taken care of the end=of=life issue,both

legally with an attorney and verbally to all of my kids.

[enough]

7. Virgogal, have you specifically dealt with the issue of dementia?

If so, I would be most interested to know how you have done that. I'm sixty seven, with a lot of recent family experience of dementia in old age in my family. (Typically it comes on in the mid-eighties in my family.)

How have you dealt with this situation: You are in your mid-eighties. You are remarkably healthy and fit for your age. You have signed all the papers saying you don't want extraordinary measures if you should become ill. But you are not physically ill. You are just not of sound mind any longer. When you were in your right mind, you said that you did not want to live beyond a certain level of ability to take care of yourself. What happens now that you are no longer able to take care of yourself? Who is going to help you die, and how? You are not sick, you are not in any sort of pain, you do not have any kind of physical emergency. You are far beyond the ability to commit suicide yourself, or even to understand that you once passionately believed that you would not want to live like this.

How have you taken care of this situation legally with your attorney and with your kids?

This is very different from a family deciding to pull the plug, or deciding not to begin certain kinds of treatment. This is not a rhetorical question for me. I'm seriously looking for answers.

[virgogal]

9. You are describing my mother's situation to a T. She lived

about 8 years too long---suffering with dementia,and a sad,weepy dementia it was. Her physical health was excellent.She died at 91.

There really is not much that can be done once the dementia has reached a certain point. Anyone helping you die would be in

legal trouble because of the fact the elderly person couldn't make an informed decision. The arrangements can't be made in

advance(legally) because assisted suicide is a crime in MA. I have one daughter(out of 6 kids) that I have discussed this with and she

knows how I feel but whether she would help me----I don't know for sure, but feel I feel she would.

It's a most perplexing problem.

Good luck to you.

[xchrom]

6. This is a difficult issue for me.

I lived through w/ my dad.

There are issues involving my mom & my dad's decline I can't talk about.

[Warpy]

8. My mother's doc sure didn't want to hear any of it

especially my mother's insistence she didn't want dialysis. They really did try to put in a shunt during her last hospitalization, thinking a slightly demented octogenarian wouldn't make a stink over it. Bad mistake, I understand the shriek for them to get the hell out could be heard all the way to Cape Canaveral.

At my last hospital, the chaplains were the ones who talked over the final directives with the patients and they were the best people to do so.

The bottom line is that somebody needs to have a frank talk about enjoying the balance of life or prolonging death with heroics. A lot of docs have bought into the conceit that death is always the enemy and won't do it.

I'm afraid some of the people who need to take up the slack are family members.

[CrawlingChaos]

10. Yet another article encouraging the elderly to die quickly

Die as quickly and cheaply as possible, as soon as they become ill.

I really couldn't be more cynical about this issue. The perpetuation of this MYTH that doctors won't engage in this "tough talk" makes me want to tear my hair out. Maybe some individual physicians with longstanding patient relationships might be reluctant - I don't know - but you take an elderly or disabled person to pretty much any hospital and you will be faced with an onslaught of pressure from doctors and hospital administrators to make those "tough decisions". And it's not a discussion, it's a badgering session, based on my extensive personal experience.

There are already forces at work trying to deny medical care to vulnerable people. And not heroic measures either - I'm talking basic care. Old people using too much health care is NOT the problem. Greed is the problem.