Dr John M

cardiac electrophysiologist, cyclist, learner

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We must inject more care into healthcare

October 25, 2015 By Dr John

A frail elderly women has a leaky heart valve. It caused her legs to swell and increased her work of breathing when she pushed her walker around the house.

One doctor wanted to relieve her suffering. She suggested palliative care; she wanted to make her disease less severe but without removing the cause. Other doctors said no, the answer was to cut the bad valve out and fix the disease.

It’s America; you know what happened.

After heart surgery, which was successful in relieving the leaky valve, her health deteriorated. (My wife Staci talks often of the elderly and the house-of-cards analogy.)

A prolonged post-op course led to a nursing home stay, then more hospital admissions, for infection, falls, fractures, then more infections, a blood clot, chronic pain, and, after eight trips back to the hospital in her last 18 months, this women died an American death: hospital lights blaring, tubes attached, monitors beeping. Delirium added to her family’s suffering. During all this, while her humanity leaked away, the repaired heart valve remained perfectly competent.

You could tell the same story with a different surgery, or chemotherapy for cancer, or many other scenarios of death denial. But it does not have to go like this.

BJ Miller is a doctor. He is also a patient.

The title of his talk is: What really matters at the end of life.

It’s worth 20 minutes of your time.

JMM

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Related posts:

  1. Right Care Action Week — rational care
  2. I will host Hospice and Palliative Care Tweet Chat — #HPM
  3. Because there is nothing else to do
  4. End of life care – A great American tragedy.

Filed Under: General Cardiology, Health Care, Health Care Reform, Hospice/Palliative Care

John Mandrola, MD

Welcome, Enjoy, Interact. john-mandrola I am a cardiac electrophysiologist practicing in Louisville KY. I am also a husband to a palliative care doctor, a father, a bike racer, and a regular columnist at theHeart.org | Medscape

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  • Electrophysiology commentary on Medscape/Cardiology

Mandrola on Medscape

  • My Medscape column on general medical matters

For patients...Educational posts

  • 13 things to know about Atrial Fibrillation — 2014
  • A new cure of AF
  • Adding a new verb to doctoring: To deprescribe is to do a lot
  • AF ablation — 2015 A Cautionary Note
  • AF Ablation in 2012–An easier journey?
  • Atrial Flutter — 15 facts you may want to know.
  • Benign PVCs: A heart rhythm doctor’s approach.
  • Caution with early Cardioversion
  • Decisions of 2 low-risk cases of PAF
  • Defining success in AF ablation in 2014
  • Four commonly asked questions on AF ablation
  • Inflammation and AF — Get off the gas
  • Ten things to expect after AF ablation
  • The medical decsion as a gamble
  • The most important verb in our health crisis
  • Wellness Requires Ownership

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