Dr. John Lerma Weblog

By Dave Fehling / 11 News - Tuesday, April 22, 2008

HOUSTON — It’s one of the toughest times we face as families: When an elderly parent is terminally ill, how much should we do to keep them living?

In Houston, it turns out that we may be doing a lot — maybe too much. It’s been nine years ago this month that Lisa Jobe’s stepfather died of lung cancer. “It came as quite a shock to our family,” she said. A shock because he was just 69. In the final months of his life, he got the best of care at M.D. Anderson Cancer Center, but now in hindsight, she wonders if all that care was really necessary.

“At one point, I remember my mother and I talking about how we’re just going through the motions here because this is what we’re supposed to do?” Jobe said.

Is there such a thing as too much medical care? Money wasted on care that doesn’t necessarily improve one’s health or longevity? That’s what’s suggested in a new study about big medical complexes like the Texas Medical Center.

Dartmouth Medical School did a nationwide study of how much the government’s Medicare program spends on elderly patients in the last six months of their lives.

Houston hospitals charged the government about $33,000 on average. That’s more than in Beaumont, Dallas or Austin — and way more than in Bryan. And in Houston, doctors saw patients more often: some 45 visits in their last six months. It was more often than doctors in those other Texas cities and nearly twice as often as doctors in Bryan. But isn’t the care better in Houston? In general, the Dartmouth study said no.
“Hospitals … that use more services per patient do not necessarily have higher quality care. In fact, it is slightly worse,” the study said.

Dr. Susan Krauter specializes in caring for the terminally ill. “I think a lot of money is used that looking back, we can say wasn’t such a good idea,” she said. She works at Houston Hospice, a beautifully-furnished, landscaped facility in the shadow of the Texas Medical Center.

“The approach here is death is not the enemy,” CEO Jim Monahan said. Monahan runs the hospice where dying patients are made as comfortable as possible. He said he doesn’t fault someone for wanting to do everything possible to prolong life, but said more families are now considering whether its truly worth it.

“Do I want to be traipsing into the doctor’s office, going through a lot of treatments that may or may not work?” he said.

But as we put this story together we were warned to be careful of this: the “Myths of the High Medical Cost of Old Age and Dying.” Dr. Robert Roush points to other studies that say only about three percent of Medicare patients run up unusually high medical bills in the final months of their lives.

According to a report by the Mt.Sinai Medical School, “many older people who receive aggressive care survive and do well for an extended period.”In other words, its not money wasted even if their days left are limited.

“What’s the value of seeing a few more great sunsets?” Dr. Roush said. “Is that worth it? To me personally it is.” He also said there are reasons why Houston’s costs may be higher with its concentration of cutting edge hospitals that attract some of the most seriously ill patients seeking the most advanced care.
Like Jobe’s stepfather. “He was not going to get better,” she said. She has no regrets and said her stepdad died at peace, but she can’t help but wonder if all that costly care made any difference.

Click here to see the study that ranks Houston hospitals and compares them to others across the country.
Click here to watch the video on 11 News

To Oprah:

Feb 1, 2008
Although there are many issues and areas where a large amount of money could do the most good, for me there is no second guessing or thought that would have to go into deciding where best to put your proverbial “money where your mouth is”. There are indeed two very specific areas where I think it could do the most good. I only wish I could be one of the ten who could have this opportunity.

First and foremost, I would give money to Hospice organization. Having lost two very dear loved ones to the ugly disease of cancer, I can'’t begin to say how grateful I am that Hospice has been there, not only for my family, but for countless others. What Hospice does to help alleviate the heartache and pain that the survivors experience, and more so what they do for the unending number of patients they care for is far beyond the call of duty. The caregivers who work for Hospice have the most difficult job of any that I can think of, and yet their caring and nurturing nature can not be matched. They make the transition of life to death much more bearable for the individuals who need that service. I would want to insure that facilities that have cared for my loved ones have everything they need by providing them with a contribution that would certainly go a very long way.

Second, to my local homeless shelter. Here in Lancaster, Pa. we have a facility called the ‘”’Water Street Rescue Mission”'’. This non-profit organization relies solely on contributions and volunteers. Just recently they have gratefully had the opportunity to add to the long list of needs they meet, dental service for the homeless. However there is a very long way to go, they still need to add more space to an already overcrowded facility. They are in desperate need of more living space, housing, medical care, clothing, food, and all of the applicable necessities to help the homeless get off the streets and out of the cold. It simply breaks my heart to hear or read that yet another homeless individual or family has no place to go or that they are sleeping under bridges or in card board boxes to try and stay warm, and worse that another individual has been found frozen or starved to death. This is absurd at best. Why I ask?, in this great United States do we have such poverty? It is just unacceptable that we should have anyone starving, or homeless, or with no place to keep children safe from the elements of weather. There should never be a single soul who should have to look into a trash can to find something to eat!

Ask me Oprah, what I would do with a bundle of cash, better yet, pick me for your endeavor and I'’ll show just exactly what I would do!

…and finally, Thank you Oprah, for all you do and all you give back to the vast array of projects you are involved with. You are indeed an Angel