Honoring patient preferences and rationing intensive care: Are these compatible goals?

Article Abstract:

Intensive care services are expanding rapidly, but intensive care is expensive to provide. Health care in general accounts for 11 percent of the United States gross national product, and intensive care services consume 1 percent of the GNP. Medical services and technology are expected by the public, but at the same time, the public is beginning to recognize that these services cannot be provided in an unlimited fashion, because of a lack of resources. Despite this general understanding of the scarcity of resources, most individuals want and expect intensive care services to be available to them, even when the likelihood of benefit is minimal. The intended purpose of critical care services when they were first developed was to provide the intensive therapy needed to care for the critically ill who would most likely benefit from that therapy. Since intensive care services are now being provided to virtually anyone who is critically ill, regardless of likely outcome, rationing of intensive care services is likely to occur in the future. Economic arguments to determine allocation of care should only be used in a broad sense, to establish what treatments are worth funding, and not in individual cases, to decide which patients should receive treatment. A change in attitude toward terminal illness is also necessary, for both physicians and patients. Death must be recognized as the natural outcome of life, not merely as medical failure. A presidential commission to study rationing intensive care services is one possible method of addressing these issues. (Consumer Summary produced by Reliance Medical Information, Inc.)

Economic aspects, Terminal care, Ethical aspects, Intensive care units, Critically ill, Social medicine, editorial

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The effect of patient-carried reminder cards on the performance of health maintenance measures

Article Abstract:

Various health professional groups have recommended that certain medical tests and procedures be performed routinely to prevent disease and to promote health. However, a limited number of these recommendations were established on the basis of well organized scientific studies, and many recommendations are not routinely followed. Studies have shown that reminders to the physician and checklists inserted in patients' charts have improved the performance of recommended medical procedures. However, patients are rarely involved in the performing recommendations for their own health care procedures. The usefulness of health maintenance cards carried by patients in increasing the performance of specific health maintenance procedures was assessed. Patients were instructed to show the cards to physicians at scheduled appointments to remind the physicians to perform certain medical procedures. These included influenza vaccination, pneumococcal vaccination, rectal examination and hemoccult test to determine blood in the feces, Papanicolaou smear to screen for cervical cancer, physician breast examination, and mammography or breast X-ray. Prompt sheets attached to patient charts also served as a reminder to physicians. Cards and prompt sheets were provided for 175 patients, whereas only prompt sheets were attached to the charts of 248 patients. The health maintenance cards increased the performance of influenza vaccination, rectal examination and hemoccult test, Papanicolaou smear, and physician breast examination. (Consumer Summary produced by Reliance Medical Information, Inc.)

Methods, Reports, Telecommunications systems, Health promotion, Medical screening, Health screening, Medical personnel and patient, Medical personnel-patient relations

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