Managed Care

 

One Question

One Question

Steven Peskin, MD

At a recent Grand Rounds, a leading clinician medical ethicists told of a meeting with members of the family of a critically ill 6 week old boy who had been in a neonatal intensive care unit since birth. At the meeting were the mother and father, both sets of grandparents, an and aunt and uncle, three members of the hospital ethics committee and physicians and nurses who were caring for the seriously ill child. The one question that our speaker posed to the parents and any other family members that chose to offer a response:

"For what do you hope for your son/ grandson/ nephew?" 

The mother responded, "No more blood drawing". The child had almost exhausted venous access and appeared comfortable until a blood drawing that required several sticks and intense pain for the child. 

The father said, "We want our son home." 

A grandmother whispered to her daughter, "We want a baptism". 

The physician ethicists said to the family, "Your child is not going to gain weight." The family responded their understanding (your child is going to die). To the chagrin of the clinical team, the ethicists said that we will not draw any more blood and we can arrange for your child to go home. 

The child was baptised and died peacefully one week after discharge. 

This profound and powerful question is central to advanced illness, end of life care. I believe that we should also reflect on this question much more frequently than we do in more routine medical care. We must be vigilant not to let our own predispositions, value system, and preferences supercede those of the individuals that we austensibly helping and healing. 

Meetings

Private Health Insurance Exchanges Conference Washington, D.C. October 7–8, 2014
National Healthcare Facility Management Summit Palm Beach, FL October 16–17, 2014
National Healthcare CFO Summit Las Vegas, NV October 19–21, 2014
National Healthcare CXO Summit Las Vegas, NV October 19–21, 2014
Innovative Member Engagement Operations For Health Plans Las Vegas, NV October 20–21, 2014
4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014