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 Response Page - Hammes  Interview -      


These comments are responses to the questions listed below,
which were generated in regard to the
Bud Hammes Interview of
07-15-2011.
 

Overview

Today's discussion covers a Civic Caucus meeting with Bernard (Bud) Hammes, Director of Medical Humanities and Respecting Choices, Gundersen Lutheran Medical Center, La Crosse, WI. Hammes discusses a program he started to encourage individuals to make decisions about their future care before they become ill. He describes the motivations for the effort and its impact: less stress on families, greater peace in the final years of life, and substantial savings in forgone cost of care. He discusses the politics and pragmatics of starting and running the program.

For the complete interview summary see: http://bit.ly/nrYmtM

Response Summary:  Readers have been asked to rate, on a scale of (0) most disagreement, to (5) neutral, to (10) most agreement, the following points discussed by Hammes. Average response ratings shown below are simply the mean of all readersí zero-to-ten responses to the ideas proposed and should not be considered an accurate reflection of a scientifically structured poll.

1. Uninformed decisions common. (8.6 average response) Making life-or-death decisions for extremely ill persons without knowing their wishes is an all-too-common problem around the world.

2. More treatment not always better. (8.0average response) It's a fallacy that more care extends life. Hospice care and palliative treatment rather than continued acute care can help people live longer with a significantly better quality of life.

3. Planning increases satisfaction. (7.9 average response) People doing end-of-life planning in advance of critical illness are far more satisfied with their care than those don't do such planning.

4. More treatment rewarded now. (8.5 average response) The current health care reimbursement system rewards health care providers for providing more treatments, even if such treatments aren't desired. 

 

Response Distribution:

Strongly disagree

Moderately disagree

Neutral

Moderately agree

Strongly agree

Total Responses

1. Uninformed decisions common.

0%

4%

4%

43%

50%

28

2. More treatment not always better.

4%

7%

4%

43%

43%

28

3. Planning increases satisfaction.

4%

4%

19%

26%

48%

27

4. More treatment rewarded now.

0%

4%

7%

37%

52%

27

Individual Responses

Jan Hively  (10)  (10)  (8)  (8)

Excellent presentation that deserves broad coverage.

Lyall Schwarzkopf  (9)  (7)  (5)  (7)

Tom Spitznagle  (5)  (7)  (7)  (7)

R. C. Angevine  (7.5)  (7.5)  (7.5)  (7.5)

2. More treatment not always better. While I am not sure that it actually extends life in any real sense I absolutely agree that it results in a better quality of the life remaining for both the patient and the family and friends that spend that time with them.  The only concern I have is that it is sometimes difficult to determine at what point the decision to suspend acute care should be made.

3. Planning increases satisfaction. Sounds like a reasonable outcome.

4. More treatment rewarded now. I agree and feel that needs to be changed.  What use is a well-trained physician that you have perhaps dealt with for years if he/she can't sit down and talk about your future with you unless a treatment or service is being performed?

Amanda Giliotti  (7.5)  (10)  (5)  (5)

1. Uninformed decisions common. As an estate-planning attorney I draft many health care directives so it may be common but not for many who have addressed this issue.

 2. More treatment not always better. I have seen this [to] be the case personally.

 3. Planning increases satisfaction. Hard to know is they are more satisfied or not. I have seen a number of people who did their end of life planning almost last minute and they appeared satisfied as well.  I think having a plan is where the satisfaction comes from.

4. More treatment rewarded now. I have no idea if this is actually true or not.

Chris Brazelton  (10)  (7.5)  (10)  (10)

Anonymous   (10)  (10)  (10)  (10)

1. Uninformed decisions common. This happens every day. We have not learned as a society to have these discussions with our loved ones.

2. More treatment not always better. I work with Hospice and Palliative Care and strongly support this. Since implementing Palliative Care consults, we are seeing more patients have their symptoms controlled and able to go home with assistance rather than die in the hospital. It really does extend patients lives and provides more comfortable days.

3. Planning increases satisfaction. We ask our patients that question and this is the response we receive. They thank us!

Polly Bergerson  (10)  (10)  (5)  (7.5)

2. More treatment not always better. Since I have participated in this process. I am thankful for the wonderful care that is offered to allow a person the respect and dignity of making the choice to end their own life quietly.

3. Planning increases satisfaction. I don't know -- some people want to take advantage of the medical care available and I do not know it that was a satisfying decision or not.

4. More treatment rewarded now. I think the majority of health care providers truly are concerned for their patients. However, the reimbursement for care may have them err on the side of too much information for prolonging life rather than allowing a patient to make a decision on more or less care.

Jack Evert  (7.5)  (0)  (7.5)  (10)

Ray Ayotte  (10)  (7.5)  (10)  (10)

Dave Broden  (7.5)  (2.5)  (0)  (5)

1. Uninformed decisions common. While I strongly agree with the statement this is an individual and family decision not government. There is far too much big brother stepping into this discussion as if people themselves cannot sort [this] thin out. Early awareness of need for individual commitment to the type of care is perhaps OK but not to be driven by experts .

2. More treatment not always better. A counter argument if this is true can be if extended care makes no difference then the medical community should stop all research and work which is addressed to the elderly and focus health care to children and people, letís say no older than about 60. Any thought about that?

3. Planning increases satisfaction. Would like to see some good facts not opinions---I have known many who did no planning but were very happy with the care and effort to help them. Is someone suggesting that if you do not plan you will automatically be negative? Silly thought of some expert trying to tell people how to act.

4. More treatment rewarded now. This [is] one of those which-side-are-you-on issues.

Don Anderson  (10)  (7.5)  (5)  (7.5)

John Sievert  (10)  (7.5)  (10)  (10)

2. More treatment not always better. Depends on the illness and situation.

Peter Hennessey  (2.5)  (2.5)  (2.5)  (2.5)

1. Uninformed decisions common. I have no idea; none of my relatives were that unlucky or that irresponsible.     Every doctor and every facility I ever came in contact with on their behalf always insisted on end of life instructions being clear and in writing. I don't know where in America anyone could possibly escape having to face this issue. I never saw a shortage of people, including the patient's doctor, nurse, social worker and hospital administrator, who come around repeatedly to ask if we had decided on any specific instructions, if we have any questions, or if they can help us made decisions.     I don't see why there has to be a program set up to do something that these people are already doing and logically must do before they start on any treatment or procedure on a patient. At a time when we already have way too much overhead in the health care delivery system -- government bureaucrats, insurance company bureaucrats, hospital compliance enforcement bureaucrats, etc. -- the last thing we need is more bureaucrats.    The problem belongs to the patient and his doctor. They and the patient's family are the ones to make the decisions.

2. More treatment not always better. How can anyone make such absurd, sweeping generalities? It greatly depends on a particular patient's specific condition. Is this a medical or a financial decision? Who decides what the patient's quality of life is to be?

 3. Planning increases satisfaction. Same answer.  People having made plans and therefore having definite expectations might even be more dissatisfied if their expectations are not met and if they interpret the facts differently. So how could anyone possibly make an assertion such as the one made in this question? You can't make generalizations of this sort except in a meaningless statistical sense, which is not applicable in any one particular case.

4. More treatment rewarded now. Definitely not in my experience. Who is doing the "desiring" of treatment? Who is forcing "undesired" treatment on the patient? I never saw any doctor with so much free time in his hands, and a facility so underused, that they would do unnecessary, "undesired" treatment on a patient just to pad their bill. I have seen medical bills becoming more detailed, specifically charging separately for more things, as the reimbursement rates from Medicare kept falling and more and more private insurers followed Medicare's example. But that is not the same thing as providing unwanted, unnecessary care, just to pad the bill. It is just a normal reaction to shortsighted bureaucratic stinginess. There is an (evil) agenda behind these questions and the way they are presented. Sure, we want to run health care along sound business principles. Who wants to waste precious resources? But the decisions are not made in vacuum and they are not made by disinterested committees in some far-off bureaucracy; they are made by the patient's family and their doctors. Or at least in saner times, in a saner society, that's how it has been done.  All questions such as these would be moot if the financial arrangements were free of third party interference. Insurance companies like to collect premiums but hate paying bills. The politicians of a certain stripe like to mandate "free" government benefits, then harangue the rest of us to pay more taxes. And both put the screws to the professionals who actually perform the services. If the medical and financial decisions were made between the doctor and the patient's family, all these issues would be simpler and fairer to everybody, and third parties with their statistics-based rulings would be kept at bay.

Bert Press  (10)  (10)  (10)  (10)

Arvonne Fraser  (8)  (10)  (9)  (10)

Thanks for doing this discussion.

George Pillsbury  (8)  (5)  (8)  (7)

Carolyn Ring  (7)  (8)  (5)  (10)

When a person is not sick, he/she will often make decisions about end of life circumstances that will be very different when they actually are experiencing the situation.  A document that is signed well in advance of an end-of-life situation may be very different.  As Christians our goal should be to die and go to heaven with the Lord, but there is something about the known that often keeps people taking treatments that they previously thought they would not want to do.  I agree the concept is a very good one, but there must always be safeguards for people to change their minds. 

4. More treatment rewarded now. Too often nursing care facilities will do therapy and other treatments for people that are dying and the therapy or treatment will do them no good, but Medicare will pay for it, so it is done.  There is no doubt this whole subject is very complex, but one that should be discussed.

Will Shapira  (na)  (na)  (na)  (na)

You'd think at 75 I'd have a lot of good answers but I do not. I think some of the questions can be answered knowledgably only by people in the medical profession. The others either do not or have not affected me or I just don't feel confident of my answers.

Wayne Jennings  (10)  (10)  (10)  (10)

Iím elderly and want this program for myself. I think others would also.

Terry Stone  (10)  (10)  (10)  (10)

William Kuisle  (6)  (8)  (8)  (8)

Chuck Lutz  (9)  (8)  (10)  (9)

Clarence Shallbetter  (9)  (9)  (na)  (na)

One item it think is missing is a note about the handout Hammes distributed which enables a person to write down their instructions- as little as designating a person responsible for making decisions when the patient cannot do it to the essential updates this document needs as conditions and illnesses develop. It's this continuous engagement as health challenges occur that make the process most useful for the physicians, the patient and the family.

Bright Dornblaser  (10)  (10)  (10)  (10)

Fred Senn  (10)  (10)  (10)  (10)

I have heard about the great work in La Crosse. This is a tremendously important discussion. This should be a Time Magazine cover story, or 60 Minutes feature. We have to find a way to protect our politicians from the third rail. The concept will need loud endorsement from respected groups.  AARP, American Medical Association, Mayo Clinic, etc. Minnesota is well positioned to lead.

Shirley Heaton  (10)  (10)  (10)  (10)

The trick is to get the medical profession to recognize this situation and accept the fact that adjustments have to be made in their saving lives obsession.

Tom Swain  (7)  (9)  (10)  (10)

    

The Civic Caucus   is a non-partisan, tax-exempt educational organization.   The Core participants include persons of varying political persuasions, reflecting years of leadership in politics and business. Click here  to see a short personal background of each.

   Verne C. Johnson, chair;  David Broden, Charles Clay, Marianne Curry, Bill Frenzel, Paul Gilje,  Jim Hetland,  Marina Lyon, Joe Mansky, John Mooty,  Jim Olson,  and Wayne Popham 


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The Civic Caucus, 01-01-2008
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