Sunday, May 28, 2017

why dn't we give her morphine HAHA

Awhile back, I wrote about a resident moonlighting at the ER at our rural IHS hospital, who wen asked to check a feeding tube position in an old Lakota Lady with a recent stroke, said "Why not gie her morphine, haha"... 
and the IHS doc, looking like he was ready to throttle him, said" We don't do things like that around here" and told the nurses he'd drive back later to check the x ray.

Well, now HPR says the same thing. Oh yes, they use worst case scenerios, but essentially they are saying the same thing. and he has an excuse even though he acknowledges the problem of a doctor meeting someone (often a minority) for the first time making this decision.

Researchers who interviewed emergency room staff at two Boston hospitals, for instance, found resistance to palliative care. ER doctors questioned how they could handle delicate end-of-life conversations for patients they barely knew. Others argued that the ER, with its "cold, simple rooms" and drunken patients screaming, is not an appropriate place to provide palliative care, which tends to physical, psychological and spiritual needs.
Ouchi saw some of these challenges during his residency in New York, when he visited the homes of older patients who frequently visited the emergency room. He saw how obstacles like transportation, frailty and poor vision made it difficult for them to leave the house to see a doctor.
"So what do they do?" Ouchi asks. "They call 911."

so maybe make evening clinics? House call services?
then he brings up:

When older adults are very ill — if they need an IV drip to maintain blood pressure, a ventilator to breathe, or medication to restart the heart — they are most likely to end up in an intensive care unit, where the risk of developing hospital-acquired infections and delirium is increased, 
 then again, why not put them in a regular room?

As for hospital acquired infections: THAT is a problem that needs to be addressed, not used as an excuse to let people die.

Bring in the Qaality of life stuff to ration care.

One such screening tool, dubbed P-CaRES, developed at Brown University in Providence, R.I., gives ER doctors a list of questions. Does the patient have life-limiting conditions such as advanced dementia or sepsis? How often does the patient visit the ER? Would the doctor be surprised if the patient died within 12 months?
all that stuff about "palliative care doctors" is merely another way to specialize.

We old time dosc did this all the time, but superspecialization (plus the threat of law suits if we don't overtreat) has made us refer...

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