Moderator True Anomaly Posted September 28, 2014 Moderator Share Posted September 28, 2014 I'll add if only we can get most of these elderly folks off of sedating and addictive substances that I see so many of them on- opioids, benzos, Ambien/Trazadone for "sleep", etc. Link to comment Share on other sites More sharing options...
JohnnyM2 Posted September 28, 2014 Share Posted September 28, 2014 Interesting. My 93 year old mother has never had anything but multiple myeloma. They don't screen for that! She is currently on Revlimid maintenance ( 3 plus years) and doing just fine. She has never had a colonoscopy and stopped getting mammograms some years ago. I recently got her to stop taking morphine which she hasn't needed for some time, got her off BP medicines since she got dizzy every time she got up ( I am monitoring her BP). I also got her to stop drinking wine with dinner. IMO, she is doing better. I shudder to think what happens to elderly people who have no one looking out for them and I wonder how much it costs Medicare to screen very elderly people for diseases they aren't likely to get when they are already way past their life expectancies, and to provide them with meds they don't need. We have an old family friend, also in his 90s, who seems to spend half his life seeing doctors just to be sure he will live forever. It's nuts. Sent from my Kindle Fire HDX using Tapatalk 2 Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted September 28, 2014 Moderator Share Posted September 28, 2014 Interesting. My 93 year old mother has never had anything but multiple myeloma. They don't screen for that! She is currently on Revlimid maintenance ( 3 plus years) and doing just fine. She has never had a colonoscopy and stopped getting mammograms some years ago. I recently got her to stop taking morphine which she hasn't needed for some time, got her off BP medicines since she got dizzy every time she got up ( I am monitoring her BP). I also got her to stop drinking wine with dinner. IMO, she is doing better. I shudder to think what happens to elderly people who have no one looking out for them and I wonder how much it costs Medicare to screen very elderly people for diseases they aren't likely to get when they are already way past their life expectancies, and to provide them with meds they don't need. We have an old family friend, also in his 90s, who seems to spend half his life seeing doctors just to be sure he will live forever. It's nuts. Sent from my Kindle Fire HDX using Tapatalk 2 The balance between "reactive" and "proactive" medicine still seems to be tipped far into the former, in our society as a whole. Hence the oft-quoted line of "most healthcare dollars are spent in the last year of someone's life" Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted September 28, 2014 Author Share Posted September 28, 2014 The balance between "reactive" and "proactive" medicine still seems to be tipped far into the former, in our society as a whole. Hence the oft-quoted line of "most healthcare dollars are spent in the last year of someone's life" Heck, if you trust the 60 Minutes story from a year or so back, the greatest outlay of Medicare dollars is in the last couple of WEEKS of life (as I recall, but then again I haven't scheduled my recommended annual memory screening assessment through my PCP as of yet). Link to comment Share on other sites More sharing options...
JohnnyM2 Posted September 29, 2014 Share Posted September 29, 2014 Heck, if you trust the 60 Minutes story from a year or so back, the greatest outlay of Medicare dollars is in the last couple of WEEKS of life (as I recall, but then again I haven't scheduled my recommended annual memory screening assessment through my PCP as of yet). Undoubtedly true but is that where most of the WASTE is? I have no issue with the fact that the elderly are expensive in terms of their health care. My issue is the waste that could be easily avoided and that offers them no benefit. BTW, I have NEVER believed that the government is the solution to this problem. Sent from my Kindle Fire HDX using Tapatalk 2 Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted September 29, 2014 Author Share Posted September 29, 2014 Would you consider screening colonoscopies or Pap smears on elderly female patients who are in an ICU environment wasteful? These were some of the examples mentioned. In this setting there is specialty chum in the water. Link to comment Share on other sites More sharing options...
Guest JMPA Posted September 29, 2014 Share Posted September 29, 2014 Would you consider screening colonoscopies or Pap smears on elderly female patients who are in an ICU environment wasteful? These were some of the examples mentioned. In this setting there is specialty chum in the water. colonoscopies are wasteful, literally Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted September 29, 2014 Author Share Posted September 29, 2014 Especially pre-procedure. Thank you. I'll be here all week with two shows next Saturday. Link to comment Share on other sites More sharing options...
db_pavnp Posted September 29, 2014 Share Posted September 29, 2014 If we are on the subject of waste, let's throw out more examples of the waste we see everyday. I run all the labs for an inner city ER, so every UTI gets amylase, lipase, CMP, CBC, UA, drug screen, preg test(f). Link to comment Share on other sites More sharing options...
cbrsmurf Posted September 29, 2014 Share Posted September 29, 2014 Along a similar thread, why do folks keep looking for/treating conditions in folks that are in their 80's plus (no offense intended to those in their 80's plus)? Statins (finally got my mom off the stuff for primary prevention)? Colonoscopies (wonder what the perf NNH, or number needed to harm, rate is in this specific demographic group)? Mammograms, or better yet, cervical cancer screening? Thank goodness we finally put two and two together and realized that these folks don't necessarily need to be <140/90 mmHg on their BPs (kind of like ezetimibe as your numbers look great while you're lying in the casket) and someone put the lid on screening for prostate cancer past 75 y/o, assuming of course that anyone even knows of the recommendation. I realize that there are exceptions and that some octogenarians are gung-ho at 80 but reality says most aren't. This has become my most frequent reason for approaching attendings at my workplace in that I'm asking them why do we have these folks on all this crap? Not surprisingly, they don't have an answer. The best predictor of how a clinician practices today is how they practiced yesterday. Link to comment Share on other sites More sharing options...
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