Monday, November 25, 2013

Medical creep

Medical creep is not a healthcare worker who behaves inappropriately.

Medical creep connotes the tendency for healthcare providers to prescribe procedures and treatments for patients in the absence of evidence that demonstrates the procedure or treatment will benefit the patient.

The popularity of CPR (cardio-pulmonary resuscitation) illustrates medical creep. Before 1960, the only treatment for a heart that stopped was heart massage. A physician – usually a cardiac surgeon – would open the chest and manually massage the heart, thereby pumping blood through the body. A Johns Hopkins 1960 study described an alternative approach called closed-chest cardiac massage. The method successfully resuscitated all 20 of the patients involved in the study, 14 of whom suffered no brain damage or other ill effects.

Fifty years later, CPR has become the default treatment for every person who dies.

Consequently, survival rates have plummeted. In hospitals, the success rate for elderly patients given CPR is less than 15%; as many as a quarter of the survivors suffer brain damage.

What happens?

Healthcare professionals want to save lives. Loved ones want to see their beloved saved. TV shows and media reports highlight CPR successes.

Yet not everyone with heart failure is a prime candidate for a successful CPR. Multiple factors including age, heart condition, other health conditions, and the length of time that the heart has been stopped partially determine whether even the most skillful application of CPR will succeed. (Brendan Reilly, "How CPR Became So Popular," The Atlantic, Nov. 4, 2013)

The U.S. healthcare system is the world's most expensive, offers the most advanced treatment and procedures available, and yet achieves poorer outcomes than does healthcare in most developed nations.

Identifying medical creep suggests one part of the answer to fixing our broken healthcare system. We must become better-informed healthcare consumers.

For example, I do not want CPR unless there is a reasonable chance that I will survive without significant brain damage or other major complications. I do not want doctors performing tests on me that will not alter the treatment they provide me. I do not want treatment that does not have a proven benefit for patients with my condition or, if the treatment is experimental, is likely to benefit patients with my condition. I know that death is inevitable, do not live with an illusory hope of extending this life indefinitely, and value both the quality as well as the length of my life.

The time to consider and to discuss these issues is when one, and one's loved ones, are well. Preplanning offers the hope of better living, better dying, and guilt free grief for survivors.

1 comment:

Ted said...

I agree and everyone knows my wishes. So how do we get the word out to others that quality of life is better than just living.
It will be interesting in 15 years to see what the outcome of our efforts to keep people alive who were in combat and came back with no quality of life.