I enjoyed this article from the LA Times this week. Physician and author H. Gilbert Welch writes that in 1999
“electronic fetal monitoring was used in 83% of all U.S. births. After reviewing experimental studies involving more than 37,000 women, the Cochrane Review found that the monitoring had no effect on the need for neonatal intensive care or, more important, infant survival.
“It did lead to slightly fewer seizures, but also to a lot more Cesarean sections — on the order of 100 extra C-sections to avoid one seizure.”
Was the extra 99 C-sections worth the avoidance of a single baby’s seizure? I doubt it.
Welch says that the same is true at the other end of life. He says the intensive care unit is:
being used more and more for this purpose. Between 1995 and 2005, Dartmouth Atlas data show a 25% increase in the proportion of Medicare patients spending time in the ICU during their last six months of life. The average number of days spent in the ICU went up even more — by 43%.
Furthermore, a startling number of doctors can be involved with care at the end of life. A third of Medicare patients cared for by “America’s Best Hospitals” (as designated by U.S. News & World Report) were seen by 10 or more physicians during their last six months of life. That’s right, 10 or more. It’s hard to imagine how that can ever be good.
I don’t want to suggest that extra medicine is always bad or that all those tests and interventions will always outweigh the benefits. But it does seem that the marginal benefits of more medicine are slim. And the question is why do we always want more of it? I’m tempted to go running to the doctor when my tendonitis gets inflamed or my knees ache. It doesn’t seem right that at my age I should have these problems–or that my doctors can’t seem to fix it. And so I’ve spent thousands of dollars to fix something that it seems is with me to stay. At my relatively young age, I need to adjust my thoughts. My frailty will only increase. Will I turn more and more to professionals to fix it, or will I remember that this is simply what I am?
From dust to dust…