It’s just a shame that medicine and healthcare has come down to what ‘looks good’ in the reports and statistics but requires abandonment of what’s best and most ethical for the patient. I have a patient in my ICU who recently underwent a cardiac surgical procedure but has been very slow to recover after a myriad of complications. He didn’t really want to undergo the procedure but agreed after pressure from family. He’s been slowly recovering but recently was set back by some kidney and respiratory issues. He is fully awake, aware and capable of deciding his treatment and has begun refusing certain treatments. Unfortunately, the cardiac surgical team has been fixated on the 30 day mortality target to get the patient ‘off the books’ after a discharge to a lower level of care. And they’ll do anything to get there. This poor man has been asking to be left alone and allowed to die in peace if that’s what happens and has been ignored. He’s been placed on a respirator against his wishes, has had procedures against his wishes and been treated for kidney failure against his wishes. Nursing and other staff that wish to advocate for the patient have been told to go away and mind their own business and family have failed to step in.
It’s really a shame. The first ethical principle of patient self determination and their right to govern what happens to their own body has been completely abandoned by those whose primary interest is self-promotion through good outcome statistics. All that seems to matter these days are mortality statistics and complication rates with no interest in how these outcomes were achieved, and at what cost to the poor patient. And I’ve seen this repeatedly….every time there is a complicated case or poor outcome the goal becomes the 30 day survival time frame and discharge to an appropriate level of care for the DATA, not the patient. In addition, the patient is kept in a critical care environment to ensure the outcome at the added cost, added risk of secondary infection and delayed rehabilitation. Then comes the transfer directly to a nursing facility with minimal skilled nursing care after the patient was supposedly too sick to transition to a lower lever of in-hospital care. And we want to know why healthcare is so expensive.
Sadly, so much emphasis has been made of these ridiculous outcome statistics that surgeons will pick only cases that make them look good to the exclusion of those more complicated and need the treatment. Then god forbid there is an irreversible complication, the patient is tormented until they can come off the surgeon’s ‘books’.
Unfortunately, we all know who these physicians are. I just don’t understand why the ‘system’ doesn’t care and move to eliminate these types of behaviors???? I can’t imagine it’s that difficult……