Should Physicians Be Taught To Stop Trying?

With several recent articles about $100,000 plus cancer drugs, I was reminded of a conversation I’ve had with several oncologists. We were discussing how to use advanced illness counseling from companies like Vital Decisions to help people and their families manage through a terminal diagnosis.

On the one hand, that seems like a conversation that a physician could / should have, but I’ve highlighted some research on this before. On the other hand, in a FFS (fee for service) world, there is an incentive to keep doing everything possible regardless of costs and how long it extends life. Will this change in a value based payment model? I’d like to believe it will. There is so much money spent on care in the last few months of life with limited extension of life and questionable impact on quality of life that this may become more relevant.

But, what struck me in my discussions is that the oncologists said that no one ever taught them how to “give up” on the patient. They see success in curing the patient or getting the cancer in remission. Is that success? Is it giving up to stop pumping them full of drugs with minimal value? Is there a rationale price for each day of extended life?

We typical think of healthcare as an endless bowl of funds, but what if it was limited? What if we couldn’t just keep printing money and raising the debt ceiling? Should that $200,000 be spent to get two weeks of life for a 90-year old patient in pain or should it go to feed a family and provide them with medical care for several years?

I’m not sure who wants to make those decisions but I think there will be a day when we need to think differently about some of the healthcare choices we make.