Today, the American medical community can test for, diagnose, and treat more diseases than ever before, thanks to modern technology. This is especially true for diseases that come near the end of life.
But end of life care in the U.S. involves many tests and treatments that are unpleasant for the patient, do not improve outcomes, and cost extraordinary sums. The elderly are hospitalized and treated as part of a culture of prolonging life, regardless of quality. Painful procedures often extend life for a very short period of time, during which the patient is suffering (literally) from disease, only to die shortly later from something else. “Sometimes you block the near exits, and all you’ve got left is a far exit, which is not a dignified and comfortable death,” explains Dr. Albert Mulley, director of the Dartmouth Center for Health Care Delivery Science, in “How Not to Die,” from The Atlantic.
On average, increasing spending on end of life care decreases quality of life, according to Michael Bell in Forbes. The treatments are often more unpleasant than the diseases they treat, and require being in the hospital.
The main result is that patients die in the hospital. A large study found that most people would prefer to die at home, but most actually died in the hospital, including 55% of those who would rather have been at home, according to the Dartmouth Atlas of Health Care.
“The most urgent issue facing America today, is people getting medical interventions that, if they were more informed, they would not want,” said Dr. Angelo Volandes, an assistant professor at Harvard Medical School, whose work is profiled “How Not to Die.” Volandes has performed studies showing that when people are shown videos illustrating the unpleasant realities of end of life treatments, like feeding tubes for people with advanced dementia, they are far less likely to choose aggressive treatment aimed at prolonging life, instead favoring “comfort care.” He is on a personal mission to develop videos for that purpose. As his wife, also a doctor and the voice of the videos, phrases it: “We torture people before they die.” The team is trying to change that.
If the problem stems from advances in technology, hopefully further advances and clever use of modern technological resources, like Volandes’ videos, can help reverse the trend. Potentially, mHealth systems could play a huge role in keeping the dying out of the hospital, avoiding such problems entirely.
Once a patient enters the hospital, it can be hard to get them out of a system with such an inherent bias towards keeping them alive at all costs. But if an elderly patient’s family can consult a doctor remotely, outside of the pressures of the hospital system, with the help of information like Volandes’s videos, they can determine if hospitalization and treatment are appropriate. Perhaps, mHealth can help more patients die at home, as they prefer.