Judy Citko: is the executive director of the Coalition for Compassionate Care of California. Prior to joining the coalition she worked as a lobbyist, lawyer and computer programmer for hospitals, skilled-nursing facilities and manged-care providers.
Gene Dorio: is a geriatric physician in Santa Clarita specializing in the complicated issues of end-of-life care. He believes that defining one's diminishing quality of life and beginning a discussion of palliative and hospice care are essential in the physician/patient conversation.
Susan Enguidanos: is assistant professor at the Davis School of Gerontology at the University of Southern California. She has more than 10 years' experience conducting research in aging, with a focus on geriatric health and end-of-life care issues.
Neil Wenger: is professor of medicine at UCLA and a consulting researcher at the RAND Corp. He is director of the UCLA Healthcare Ethics Center and is chair of the ethics committee at the UCLA Medical Center.
The following is my interpretation of the panel discussion and no doubt contains errors.
Wenger: We live in a great place, world class care, but we're about to enter a difficult phase. The number of older people are growing. In 2030, 5.4% will be 80 or order. These people need medical care. We over-use highly technical care. We have 26 MRI machines per million. Canada has about 5 or 6. Incentives are aligned to do more. We spend 16-18% of GDP on national health care. We don't have adequate communicate on illnesses and how technology can be useful. Example, we can get you a new liver or heart. But if we can't, you can spend weeks in a hospital until you die.
We as individuals need to answer certain questions: What treatments do we want? Do we want to be on a ventilator? Do we want to be with our kids?
Example of problems with medical care. A patient has lung cancer and will die. But we only give him medication a week at a time. Someone has to go stand in line for four hours to get him his medication. Someone can't always do this on a timely basis. Sometimes he must suffer.
Dorio: When he helps the elderly he sees his dad or himself. Listens, discusses. Final choices must be part of the decisions.
Some of his ideas to re-do health care in America: force Congress to be on medicare, greater focus on the right to die, house calls, better run senior centers.
Doctors often don't talk to patients about death as they don't have time.
Enguidanos: A hospice is meant to get the most out of your final days. Hospice means you forgo attempts for a cure. At Kaiser they pursue palliative care where you can still get services, but at home. It has found to improve longevity at a lower cost -- 1/3 lower costs.
Citko: Relationship with death is difficult. We're living longer with cronic conditions. We need to deal with this advance illness. We all need advance care planning: Advance Directive. You need someone to speak for you if you can't do so.
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