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A study of hospital regions around the country found large differences in the use of surgery near the end of Medicare patients’ lives. The extent of this practice varies widely (see map).
The most comprehensive examination of operations performed on Medicare recipients in the final year of life found that nationally in 2008, nearly one recipient in three had surgery in the last year of life. Nearly one in five had surgery in the last month of life. Nearly one in 10 had surgery in the last week of life. (The New York Times)
The researchers said their study — done from public records and with no financing — probably pointed to a real problem in American medicine: surgery, which can be painful, expensive and debilitating, is tempting for doctors and patients alike.
The New York Times interviewed Dr. Ashish Jha, an associate professor of health policy at Harvard and the lead author of the study:
“As clinicians, we often end up focusing on something narrow and small that we think we can fix,” Dr. Jha said. “That leads us down the path of surgical intervention. But what the patient cares about is not going to get fixed.”
Dr. Jha provided a recent example from his hospital. A man had metastatic pancreatic cancer and was dying. A month earlier, he had been working and looked fine.
“No one had talked to him about how close he was to death,” Dr. Jha said. “It’s the worst kind of conversation to have.”
Instead, doctors did an endoscopy and a colonoscopy because the man had internal bleeding. Then they did abdominal surgery. “We did all of this because we were trying desperately to find something we could fix,” Dr. Jha said.
The man died of a complication from the surgery.
“The tragedy is what we should have done for him but didn’t,” Dr. Jha said. “We should have given him time to have the conversation he wanted to have with his family. You can’t do that when you are in pain from surgery, groggy from anesthesia. We should have controlled his pain. We should have controlled his nausea.”
Instead, Dr. Jha said, “we sent him to the O.R.”
» Read the New York Times article.
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