August 25, 2009
New York Times
How does something as humane and reasonable as “end-of-life discussions” get turned into something as repulsive and hideous as “death panels”?
The whole thing may have started with something as benign sounding as the “medical home”, a concept some medical organizations have been pushing for. The idea is to pay primary care physicians for the coordinating functions which ordinarily they are not. It’s a way of making primary care more attractive for medical students most of whom are shunning it because of too much work and too little pay.
The coordinating activities include end-of-life discussions with patients in which doctors try to get a sense how intensively they want to be treated if their condition becomes irreversibly bad.
I suspect that when those opposed to health reform got wind of doctors being paid for “advance directives”, they manipulated the language to their advantage. By calling advance directives “death panels” they flipped president Obama’s “public option” on its back like a helpless turtle.
This might have been prevented if physicians were given a larger role in the health care debate. So far, the democratic process has circumvented them. They must be more visible and more vocal. Their input is vital and yet they are invisible. Perhaps that, more than anything else is the hallmark of the discussions so far.
Edward Volpintesta MD
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