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Profile: Arthur Kellerman
Arthur Kellerman was a participant or observer in the following events:
CNN reports that millions could be saved per year by the so-called “end of life” discussions that the Obama health care proposal would have Medicare pay for, without a loss in the quality or availability of care. According to a recent study cited by CNN, $76 million per year could be saved “if half of the people who die from cancer annually had end-of-life conversations with their doctors.… [P]atients who reported having those talks had 36 percent lower health care costs in the final week of life.” Most of the savings would come from patients who do not want extraordinary measures taken to preserve their lives, but because hospitals have no such instructions, when a dying patient “codes,” or lapses into a terminal state, hospital doctors by default will use extraordinary methods to resuscitate them. Dr. Arthur Kellerman, chairman of the emergency medicine department at Emory University, says that many aging parents and grandparents avoid such discussions because of the strain they might place on their children and grandchildren. And the younger relatives often avoid these discussions because they don’t want to appear ungrateful or grasping. As for doctors: “There are a lot of my colleagues who don’t bother having that conversation. They just intubate them, and ship them up to an ICU, and say ‘next,’” Kellerman says. “Ultimately, it drives up costs, it degrades their quality of life, and you have less money and less resources available for people who really are salvageable and have a whole lot more time left on Earth.” Kellerman says when his own mother was at the end of his life, he had to use his position as a doctor to ensure that “do not call 911, do not send her to the hospital” was written on her chart so that she would be able to die in her nursing home. “You end up with a daughter at two in the morning, and Grandma is in respiratory failure, and we’re having a conversation in a family room in the ER about what Grandma wants,” Kellerman adds. “That conversation should have been with that grandmother and her daughter and her doctor and should have happened two years earlier, and it would have been easier on everybody.” The study shows that 60 percent of elderly patients prefer that their doctors not use extraordinary measures to preserve their lives. “Everybody wants their parents to live forever, everyone wants to live forever,” says Kellerman. “But the fact is that won’t happen, and you do need to think and plan ahead.” [CNN, 7/23/2009]
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